Presented  by 
George  L  Hampton,   D.   0. 


COLLEGE  OF  OSTEOPATHIC  PHYSICIANS 
AND  SURGEONS  •  LOS  ANGELES,  CALIFORNIA 


•-;  ,: 


I 


m 

;p 


I  m . :  •• 

.  ;' '  ./ " 


r 


<^e. 


THK 


INDIGESTIONS; 


..-i 


DISEASES  OF  THE  DIGESTIVE  ORGANS 
FUNCTIONALLY  TREATED. 


BY 


THOMAS  KING  CHAMBERS, 

r  PHT-H.-IA.X  TO  H.  K.  H.  THE  PRINCE  OF  WALES,  COSSCLTISO  PHYSICIAN  AND  LICTCRBB  ox 

THB  PRACTICE  OF  MEDICINB  AT  ST.  MARY'S  HOSPITAL,  COH8CI.TISO  PHYSICIAN   TO 
TBB  LOCK  HOSPITAL,  AUTHOR  OF  "  LECTURE*  CHIEFLY  CLINICAL,"  BTC. 


SECOND    AMERICAN 

mm 
SECOND  AND  REVISED   LONDON   EDITION. 


I'll  I  LA  UKl.ril  IA: 

1 1    K  N  R  Y     C .     LEA 
1868. 


C  4  q 


PHILADELPHIA  . 
COLLINS,  I'KIMEK,  705  JAYXE  STUEET. 


PREPACK. 


1  N  1856  I  published  a  small  volume  on  the  same  subject  that 
I  arn  now%  atrain  taking  up.  It  has  been  a  good  while  out  of 
print,  for  I  was  not  content  with  it  enough  to  sanction  a 
reproduction  in  the  same  shape.  But  I  have  always  intended 
to  handle  it  again  some  time  or  another.  During  the  last  year 
I  have  been  looking  over  my  old  notes  of  cases,  and  It 
struck  me  that  it  would  be  interesting  to  pick  out  such  as  bore 
upon  indigestion,  to  classify  them  according  to  the  points  they 
illustrate,  and  see  how  far  they  upheld  or  overthrew  my 
previous  views.  Then  linking  them  together,  after  the  fashion 
of  a  clinical  teacher,  with  a  running  commentary,  I  made 
them  tell  their  own  tale,  and  added  such  observations  as  either 
occurred  to  me  at  the  time  I  had  the  patients  under  my  eye 
or  have  flowed  from  after  experience.  So  grew  up,  not  the  new 
edition  I  had  thought  of,  but  what  consistency  bids  me  call 
a  new  work.  It  has  therefore  a  new  title,  pointing  to  the 
diiVfrent  aspect  in  which  the  subject  is  viewed.  In  the  former 
work  it  was  anatomically,  hen-  it  is  functionally  treated. 

So  pleasant  has  been  the  holiday  task  thus 

t.)  tl;  of  sweet  silent  thought 

To  summon  up  remt'inl>run<-<'  <>f  things  past." 

that  1  am  lain  to  dwell  upon  it,  and  to  try  to  lead  others  towards 

-.line  source  off  njoyraent  by  describing  the  way  in  which  my 

store  has  been  heaped  M  i  is  needless  to  say  I  did  not 


iv  PREFACE. 

lean  on   raj  memory  alone,  or   the   number   of  trustworthy 
histories  would  have  been  few  indeed. 

The  cases  of  those  who  are  named  as  inmates  of  St.  Mary's 
Hospital  in  the  following  pages  are  copied  mainly 'from  the 
diary  kept  by  the  clinical  clerks.  I  have  been  always  used  to 
make  this  a  chief  source  of  teaching.  The  clerk  was  instructed 
to  take  notes  with  the  sick  person,  before  him,  and  in  his  own 
words ;  and  when  he  read  them  out  at  my  visit,  I  added  my 
observations,  sometimes  in  the  hospital  case  books,  sometimes 
in  my  own.  These  formed  the  groundwork  on  which  to  build 
my  clinical  lectures  for  the  current  week.  They  are  irregular 
in  wording,  but  preserve  a  fair  record  of  the  disease. 

The  details  of  private  practice  have  been  kept  in  a  shorter 
and  more  mechanical  way.  I  make  it  a  rule,  to  which 
exceptions  need  be  very  few,  to  write  all  prescriptions  and 
papers  of  advice  in  a  copying-book,  which  makes  a  duplicate 
of  them  by  means  of  transfer  paper ;  and  at  the  back  of  this 
transcript  I  write,  usually  with  the  patient  before  me,  his 
history,  at  least  so  far  as  to  explain  my  reasons  for  the  advice, 
before  I  go  on  to  the  next  page.  The  periodical  indexing  of 
these  sheets  is  an  easy  job  for  an  hour  of  weariness ;  and  the 
whole  time  consumed  is  so  crumbled  up  that  it  is  never  missed, 
and  neither  business  nor  amusement  feels  itself  robbed. 

Some  people  tell  me  they  can  make  their  notes  of  the  day's 
work  more  fully  and  scientifically  when  it  is  over,  and  they  are 
quiet  in  their  study.  I  do  not  like  the  plan  so  well.  For  one 
thing  it  interferes  with  the  relaxation  needed  to  keep  the  mind 
healthy  and  broad.  That  time  belongs  to  rest — datur  hora 
quieti — and  should  not  be  wasted  on  labor.  An  instinctive 
feeling  of  the  truth  of  this  causes  a  duty  which  is  put  off  to 
such  an  opportunity  to  be  put  off  often  still  further,  often 
altogether.  Again,  unless  an  immediate  note  be  made,  the  new 
and  the  strange  in  the  day's  experience  are  stamped  in  the 


!'  R  K  F  A  C  E .  V 

mind  deeper  than  the  common-place,  and  so  they  are  apt  to 
up  more  than  their  fair  share  of  room  in  the  diary  ; 
while  personal  friendships,  the  social  standing  of  the  patient, 
and  other  considerations  will  sometimes  blot  out,  sometimes 
unduly  brighten  our  recollections  of  the  case. 

To  these  brethren  in  art  then,  as  well  as  to  others  more 
emphatically  who  have  hitherto  failed  to  put  by  any  written 
record  at  all  of  their  acquired  knowledge,  I  earnestly  commend 
the  method.  Independently  of  the  advantages  to  patients  of 
being  able  to  cast  back  to  their  antecedents,  wherever  you  see 
them  again  and  at  whatever  interval,  the  not  perhaps  wholly 
selfish  satisfaction  of  living  over  again  at  will  any  portion  of 
your  professional  life  is  worth  tenfold  the  trouble  it  gives. 
;ilue  to  the  public  is  directly  proportioned  to  the  value  of 
the  individual  himself;  his  experience  is  a  simple  fraction  of 
himself. 

I  cannot  expect  the  reading  of  my  notes  to  be  as  agreeable 
to  others  as  it  is  to  me.  Still  the  gracious  way  in  which  even 
rough  clinical  sketches  are  received  in  the  shape  of  lectures, 
makes  me  hope  that  these  studies,  being  of  a  quasi-clinical 
nature,  may  have  some  of  the  same  favor  shown  them.  A  still 
higher  reward  would  be  that  my  testimony  to  the  pleasantness 
of  the  task  .should  lead  others,  richer  dowered  than  I  am,  to 
unbarn  the  harvest  of  their  experience  in  its  own  living  form, 
instead  of  merely  the  distilled  essence  of  it  in  their  opinions. 

In  this  second  edition  I  have  added  a  few  cases  which  seemed 
more  illustrative  oi'  the  matter  in  hand  than  those  previously 
quoted:  but  I  have  not  altered  the  form  of  a  running  com- 
mentary, in  which  the  work  was  first  put  before  the  public, 
and  whieh  re:  !  me  they  tind  agreeable. 

T.  K.  C. 

'2'lK.    l>i: 


CONTENTS, 


<•  II  A  1'TKK    I. 

1. \TRi.l.l  «  TluN 17 

(MIAl'TKK    FI. 

I.MiH.KSTluN  OF  VARIOUS  FOODS '_".) 

CHAPTER   III. 

II  AI;IT>  OF  SOCIAL  LIFE  LEAPINO  TO  INDIGESTION     .        .        .92 

0 HAPTER    I  V 

A  HIM, MIX. \i.  I'AINS     .........     134 

CHAPTER   V. 

VnMlTIV.  \\\~2 

('  II  A  I'TK  K    VI. 

Kl.ATM.ENCK ">4l 

<  ii  A  i-T  K  u   vii. 

IhAKlUltKA 260 

(Ml  A  I'TKII    VIII. 

.  U'ATHiN  AND  COSTIX  KNKSS "2~, '2 

<'  ii  A  I'T  i:  i;   i.\. 

fK  DlflOEIttBS  OOffNBOTXD  WITB   I  MIH;I->TI<I\       .  -2^-2 


ANAL\M>  .  305 

A  I. I'll  A  I'.K  I  I.  A  I.    I  M>K.\  .  .  317 


THE   INDIGESTIONS. 


CHAPTER  I. 
INTRODUCTION. 

SECTION  1. — Meaning  intended  to  be  conveyed  by  the  title  of  this  volume. — 
Importance  of  the  subject. — General  peculiarities  in  diseases  of  the  digestive 
vi-i-era. — Value  of  attention  to  them  in  the  management  of  diseases  of  dif- 
ferent nature. 

SECTION  2. — Divisions  of  the  subject  adopted,  and  explanations  of  terms  used. 

SECTION    I. 

THE  name  "  indigestion,"  or  "dyspepsia,"  speaks  to  the  mind 
of  the  physician  of  a  very  large  class  of  morbid  phenomena, 
various  in  their  nature  and  appearing  under  a  great  variety  of 
circumstances.  There  are  those  who  would  banish  the  words 
from  our  nosologies;  some  because  the  outward  "manifestations 
are  so  diverse  that  it  is  impossible  to  bind  them  together  in  any 
ification  of  symptoms  ;  some  because  the  parts  of  the  body 
whose  morbid  states  induce  indigestion  are  so  doubtful  and 
numerous  that  it  cannot  be  brought  under  any  anatomical  no- 
menclature. It  is  quite  true  that  a  definition  of  it  cannot  be 
<riven  according  to  the  symptoms,  and  equally  true  that  it 
not  be  railed  a  lesion  of  one  part  or  of  any  set  of  parts  or 
tissues.  l-'»r  when  symptomatic  phenomena  are  made  the  prin- 
eiple  of  classification,  those  attendant  on  this  morbid  state  are 
so  numerous  and  so  discordant  that  they  appear  in  every  • 
and  il'  the  orpins  that  origin;:'  mployed  to 

them  names  also,  there  are  very  lew  in  the  body  which  are  not 
•  ucenied    in    producing  the  disorder    in  question. 
Still  to  the  practitioner  the  name  has  a  distinct  meanin.ir.  and  is 
a  definite  guide  to  action.      N ••  - .  mptomatie,  anatomical,  or  even 
2 


18  INTRODUCTION. 

chemical  considerations  have  prevailed  over  it,  simply  because 
it  indicates  a  true  method  of  classification,  a  natural  linking  of 
facts. 

The  link  drawing  into  one  class  the  morbid  phenomena  which 
are  the  subject-matter  of  this  volume  is  a  partial  defect  in  the 
necessary  supply  of  that  of  which  the  body  is  built  up,  before  it 
arrives  at  the  medium  of  distribution. 

It  is  worth  while  to  pause  a  little  over  this  definition  and  on 
what  it  implies.  The  essence  of  "  digestion"  consists  in  absorp- 
tion from  a  canal  communicating  with  the  external  air  into  a 
closed  system  of  tubes  where  is  contained  the  nutritive  fluid. 
Preparatory  to  this  absorption  is  solution,  aided  by  nerves  and 
muscles ;  and  the  end  of  it  is  assimilation,  or  conversion  of  the 
substances  received  into  a  like  nature  with  the  fluid  they  float 
in.  Till  this  has  been  done  they  cannot  be  used  for  the  nutri- 
tion of  the  body. 

The  blood  is  the  floating  capital  lying  between  assimilation 
and  nutrition — a  treasury  liable  to  continuous  drafts  from  the 
latter,  and  requiring  therefore  constant  supplies  from  the  former 
to  keep  up  its  efficiency. 

"  Indigestion,"  then,  or  the  incompleteness  of  digestion,  is  a 
defect  anterior  to  constructive  assimilation  and  to  the  blood, 
intervening  between  life  and  the  new  matter  by  which  it  seeks 
to  renew  itself. 

This  explains  the  fact  mentioned  before,  and  familiar  to  us 
all,  of  indigestion  producing  such  an  almost  infinite  variety  of 
morbid  phenomena  as  immediate  or  remote  consequences,  and 
affecting  more  or  less  all  the  functions  of  the  body.  It  perverts 
incipient  life  at  its  very  source,  and  therefore  perverts  all  its 
future  manifestations. 

It  explains  also  why  morbid  anatomy  here  gives  us  less  help 
than  in  any  other  classes  of  disease ;  why  the  degeneration  of 
the  viscera  found  in  the  dead  body  have  less  causal  relation  to 
the  phenomena  during  life  than  in  other  cases.  The  changes 
seen  by  the  morbid  anatomist  are  those  of  solids  exhibiting ' 
faulty  processes  essentially  posterior  to  the  blood,  dependent 
on  perverted  nutrition,  or  on  mal-directed  or  arrested  destruc- 
tive assimilation. 

Let  the  use  of  a  negative  word  as  a  title  to  my  volume  stand 


INTRODUCTION.  19 

as  a  witness  of  my  }  r  belief  in  what  I  have  made  it 

my  chief  aim  to  urge  in  all  teaching  of  medical  theory  and 
practice  for  some  years;  namely,  that  all  disease  is  for  the 
ph\ -sician  essentially  a  deficiency  of  life,  an  absence  of  some 
fraction  of  the  individual  organization  of  force,  and  that  all 
successful  medical  treatment  must  aim  at  a  renewal  of  vital 
action.  I  do  not  feel  myself  called  upon  here  to  repeat  the 

•:ients  I  have  used  clinically  and  in  print  for  that  faith : 
but  I  am  more  than  ever  convinced,  as  years  roll  on,  of  the 
soundness  of  the  principle,  and  of  the  safety  of  applying  it  to 
practice. 

The  knowledge,  therefore,  of  the  deficiency  can,  in  my  opi- 
nion, be  gained  only  through  knowledge  of  that  of  which  it  is  a 
deficiency.  Physiology  is  the  only  guide  to  the  pathologist, 
and  all  just  views  of  disease  must  have  a  direct  reference  to 
health,  just  as  the  —  must  be  preceded  by  an  expressed  or 
implied  +  for  it  to  have  an  arithmetical  power. 

In  a  former  work,  alluded  to  in  the  preface,  out  of  which  the 

nt  volume  has  grown,  this  was  timidly  shadowed  forth  in 
the  arrangement  of  the  parts — "Digestion"  and  "its  Derange- 
ments"— two  books  with  an  equal  number  of  corresponding 
chapters  with  similar  headings,  each  as  it  were  complementary 
to  the  other;  the  organs  being  exhibited  by  the  first  book  in 
their  typical  state,  by  the  second  in  its  deviations;  as  both  being 
in  fact  equally  manifestations  of  physiological  laws.  My  rea- 
sons for  now  passing  over  the  first  part  of  the  subject  are  mainly 

-ire  to  diminish  the  size  of  the  volume,  and  partly  a  feeling 
that  recent  special  writers  on  physiology  have  placed  in  the 
hands  of  our  countrymen  most  of  the  information  which,  when 
I  wrote,  existed  only  in  foreign  periodicals  and  theses.  All 
that,  and  more,  is  now  so  easy  of  ac.-ess  in  a  readable  form,  that 

may  be  excused  from  reprinting  it. 

In  the  physi"!o:_M,-ul  cure  of  diseases  it  is  almost  impossible 
•  •rate  the  importance  of  the  di .  ru.     In  every 

acut  -al   or  medical,  the  modification  of  the  r 

produced  by  our  elV<>rts  depends  almost  entirely  on  how  far, 
how  wisely,  or  how  foolishly,  th  :is  are  watched  over; 

whether  they  are  well   or  ill  treated,  either  by  the  scientific 
guidance  of  the  skilled  physiologist,  or  by  the  empirical  rules 


20  INTRODUCTION. 

of  the  routine  practitioner,  according  to  the  tradition  of  the 
nurse,  or  the  instinct  of  the  patient.  Each  of  these  may  be  in 
their  fashion  a  useful  guide ;  but  the  first  is  at  least  most  capa- 
ble of  improvement  by  labor. 

As  regards  chronic  diseases  also,  science  enables  us  to  trace, 
by  steps  more  or  less  distinct,  many  of  them  not  manifested  in 
the  organs  themselves,  but  affecting  the  whole  body,  to  an 
abnormal  state  of  the  digestive  viscera.  It  is  needful  only  to 
name  gout,  tubercle,  and  anaemia,  to  engage  our  closest  attention 
to  their  causes. 

Whatever  value  we  may  attach  to  the  evidence  of  the  depend- 
ence of  disease  on  the  digestive  organs,  it  is  very  clear  that  we 
look. to  them  for  relief  from  disease.  Out  of  the  six  or  seven 
hundred  forms  of  medicines  in  habitual  use,  very  few  indeed 
are  not  occasionally  offered  to  the  stomach  for  acceptance,  and 
an  overwhelming  majority  of  them  are  adapted  for  use  only  in 
this  way.  If  we  are  still  to  employ  this  time-honored  agency 
in  our  attempts  to  cure  bodily  ailments  (and  I  see  no  threaten- 
.  ing  of  a  change  at  present),  it  is  surely  a  matter  of  great  interest 
to  secure  the  active  working  condition  of  what  our  forefathers 
in  anatomy  picturesquely  called  the  portal.  It  is  waste  toil  to 
try  and  enter  locked  doors.  A  great  advantage  of  paying 
special  attention  to  the  digestive  organs  is  that,  as  a  rule,  they 
are  more  directly  curable,  and  that  by  their  means  distant  parts, 
otherwise  out  of  our  control,  may  be  favorably  influenced. 
The  evil  of  neglecting  them  is  obstinate  disobedience  of  the 
body  of  the  patient  to  any  medicine  administered. 

When  a  sudden  poison  or  paralysis  has  fallen  on  this  gate  of 
•entrance,  our  hands  are  paralyzed  too ;  the  staffs  we  lean  on 
fail  us.  What  a  cataract  of  physic  used  to  be  poured  through 
the  half-dead  bowels  in  our  first  epidemics  of  cholera !  I  once 
found  about  a  drachm  of  Ipecacuanha  safe  in  the  stomach ;  and 
Calomel  pills  and  powders,  and  Opium,  arid  Cayenne  pepper, 
were  a  frequent  constituent  of  the  stools ;  and  I  verily  believe 
that  ninety-nine  hundredths  of  what  was  swallowed  in  the 
stage  of  collapse  followed  the  same  fate,  or  the  patients  could 
not  have  outlived  the  poisonous  doses  which  are  recorded  to 
have  been  given. 

Watch  a  case  of  typh-fever,  and  see  what  immediate  improve- 


INTRODUCTION.  21 

ment  follows  the  shedding  of  the  dead  epithelium  with  which 
the  mucous  membranes  have  been  coated — a  change  which  is 
ushered  in  by  what  is  called  the  "cleaning  of  the  tongue,"  but 
which  foreshadows  much  more,  in  fact  the  cleaning  of  the  whole 
intestinal  tract.  See  how  immediately  on  this  the  poisoned 
nervous  system  begins  again  to  renew  its  life,  and  delirium 
ifl  new  nervous  matter  fit  for  duty  is  generated.  Or 
watch  another  less  fortunate  case  of  the  same  malady,  how  as 
the  tongue  gets  dirtier  and  drier  and  browner  each  morning,  the 
weakness  of  the  nervous  and  muscular  system  increases,  and 
is  more  and  more  clouded  over.  In  both  instances  the 
diiVerence  between  one  case  and  another,  between  the  patients 
who  are  a  credit  and  a  joy  to  us  and  the  patients  who  continue 
to  wring  our  heart  with  anxiety,  mainly  lies  in  the  more  or  less 
vitality  of  the  abdominal  mucous  canal. 

We  must  remember  it  is  of  no  use  to  employ  the  best  possible 
means  of  staying  the  morbid  symptoms,  unless  the  absorbents 
assimilate  sufficient  material  to  replace  that  which  is  diseased, 
and  to  remove  which  we  are  bestowing  our  pains.  Labor  is 
wasted  in  clearing  away  a  worn-out  wall,  if  a  new  structure 
does  not  take  its  place.  To  that  end  the  only  path  is  to  insure 
-si inflation  of  food.  And  to  insure  the  assimilation  of  food, 
the  stomach  and  its  colleagues  must  be  in  working  order.  So 
that  in  point  of  fact  the  only  fair  trials  of  depletory  measures 
must  be  connected  with  feeding,  and  those  who  would  uphold 
the  good  fame  of  such  expedients  must  be  careful  of  their 
patient's  digestion. 

lint  even  if  diseases  of  the  alimentary  organs  had  not  so  much 
influence  as  they  possess  on  the  duration  of  life,  their  extreme 
frequency  would  alone  entitle  them  to  attention.  Unfortunately, 
it  has  had  a  contrary  effect:  medical  men  are  apt  to  set  down 
what  is  so  common  and  inevitable.  They  neglect  indigestion  as 
unimportant,  forgetful  that  though  its  removal  may  not  perhaps 
in  every  case  lengthen  lite,  yet  that  it  would  at  all  events  treble 
:lue  both  to  the  individual  and  to  society. 

The  digestive  tract  has  not  the  advantage  enjoyed  by  the  re- 
spiratory and  by  the  upper  part  of  the  urinary  apparatus,  and 
other  parts,  of  being  double.  An  animal  has  two  lungs,  two 
kidneys,  two  hemispheres  to  the  brain,  two  testicles  or  ovaries, 


22  INTRODUCTION. 

two  sides  to  his  body  generally ;  but  only  one  stomach,  and  one 
intestinal  canal.  A  further  reason  for  great  caution  in  preserv- 
ing the  integrity  of  the  latter — there  is  less  to  spare  for  disease 
to  affect.  A  deposit  of  tubercle  (for  instance)  the  size  of  a  nut 
in  the  pulmonary  tissue  may  be  neither  here  nor  there,  may  be 
never  known  by  its  effects.  But  put  it  in  the  peritoneum,  or  in 
Peyer's  glands,  and  what  a  disturbance  is  produced !  A  man 
may  lose  a  leg  or  an  arm,  and  enjoy  life  very  fairly  afterwards ; 
but  let  him  lose  the  use  of  his  oesophagus  or'  his  rectum,  and 
what  can  he  hope  for  ? 

This  singleness  helps  to  explain  the  powerful  influence  which 
derangement  of  any  one  of  its  parts  has  not  only  over  the  whole 
tract,  but  over  the  whole  body  and  mind.  No  chain  is  stronger 
than  its  weakest  link,  and  an  interruption  of  the  function  at  one 
point  is  an  interruption  of  the  whole. 

It  also  has  a  bearing  of  considerable  importance  on  the  treat- 
ment. It  is  extremely  difficult  to  obtain  that  rest  which  is  so 
essential  in  the  management  of  disease.  If  you  have  pneumonia, 
you  may  give  a  holiday  to  the  smitten  lung  and  generally 
recover  with  the  other;  but  if  you  have  an  equally  acute  inflam- 
mation of  the  oesophagus  or  stomach,  the  danger  is  great,  because 
necessarily  they  are  in  constant  use. 

Indigestion  is  a  chronic  disease.  By  that  I  mean  that  its 
natural  path  is  straight  on  from  bad  to  worse,  unless  from  the 
interposition  of  some  extraneous  circumstances  of  accidental  or 
designed  origin  foreign  to  the  phenomena  of  the  disease  itself. 
Hence  it  is  not  difficult  to  test  upon  it  the  action  of  a  remedy. 
A  cautious  observer  may  from  a  moderate  number  of  well-con- 
sidered cases  come  to  a  rational  conclusion  as  to  its  value.  On 
the  other  hand,  the  tendency  of  acute  disease,  as  I  understand 
it,  is  to  progress  in  a  circle  towards  the  recovery  of  health ;  each 
process,  however  dangerous  and  abnormal  it  may  be,  being  a 
step  towards  the  final  arrival  at  that  result,  if  only  the  patient's 
strength  hold  out.1  Art,  therefore,  modifies  it  much  less 

1  Dr.  Pierre  Petit,  in  the  Preface  to  his  "  Commentary  on  Aretaeus,"  compares 
acute  diseases  to  race-horses,  which  run  round  to  the  goal,  unless  they  founder 
on  the  way. 

The  Greek  primary  division  of  diseases  into  "  acute"  and  "  chronic"  is  turned 
to  such  excellent  therapeutical  account  by  Aretseus,  that  the  loss  of  his  intro- 


INTRODUCTION.  23 

glaringly  ;  a  small  experience  is  sure  to  lead  to  fallacies,  and  it 
is  only  on  the  numerical  comparison  of  a  large  number  of  un- 
prejudged  cases  that  an  opinion  can  be  formed. 

For  this  reason  the  failure  of  homoeopathy  in  the  cure  of  the 
digestive  function  is  very  conspicuous.  I  suppose  a  good  third 
of  the  private  patients  who  come  to  me  with  dyspeptic  ailments 
have  tried  this  system,  and  confessedly  tried  it  without  advan- 
tage; though  some  of  the  same  people  still  continue  to  think 
that  in  acute  disease,  in  scarlatina,  catarrh,  measles,  rheumatic 
fever,  pneumonia,  and  the  like,  their  convalescence  is  brought 
about  by  homoeopathic  drugs. 

My  object  in  this  chapter  has  been  to  point  out  the  import- 
ance of  a  skilful  management  of  the  digestive  organs  in  disease. 
I  mean  in  disease  generally,  and  not  only  that  which  speci- 
fically affects  those  organs  alone.  Let  us  not  be  deceived  by 
the  expression  "  merely  symptomatic"  sometimes  applied  to  the 
derangements  of  digestion  where  organic  changes  exist.  All 
-  and  functions  of  the  body  are  so  knit  together  in  one  to 
form  the  great  circle  of  life,  that  their  comparative  value  to  in- 
dividual existence  is  more  a  question  of  time  than  of  power. 
The  failure  of  any  one  shortens  the  days  more  or  less,  and  the 
immediate  cause  of  death  is  as  often  "  a  mere  symptom"  as  an 
organic  change.  It  is  also  a  serious  consideration  that  in  respect 
of  the  patient  in  chronic  pathological  states  this  is  in  reality 
often  the  whole  duty  of  the  medical  adviser.  Often,  on  stating 
in  consultation  an  opinion  that  some  viscus  is  chronically  de- 
generated, one  is  met  by  the  remark,  "Well,  what  is  to  be  done? 
— we  cannot  cure  that."  Very  likely  not ;  then  let  us  try  and 
find  something  else  which  we  can  cure.  In  the  great  majority 
of  patients  this  curable  something  may  be  found  in  functional 
impediments  to  the  entrance  of  nutriment  into  the  medium  of 
assimilation;  and  when  once  nutriment  can  be  got  in,  a  cur.-  is 
begun.  Do  not,  therefore,  let  us  indulge  despair  even  after  it 

dnction,  in  which  he  probably  defined  acuteness,  is  much  to  be  regretted.  Galen 
tli.-  iirnctit-al  point,  when  he  introduces  the  artificial  element  of  time, 
jied.-uitically  limiting  acuteness  to  a  definite  nuinher  of  d.iy-;.      And  several   of 
our  rc>i]tem]H>rari.'>  have  fallen  into  t;  ;  ror  :    as  if  there  could   he  any 

natural  difference  between  an  inflaunnatiuu  lasting  twenty-one  days  and  an 
intlauiniation  lasting  twenty -two  days! 


24  INTRODUCTION. 

has  become  certain  that  the  principal  viscus  which  gives  a  name 
to  the  disease  is  past  remedies,  and  though  little  can  be  pre- 
scribed for  the  part  mainly  affected.  It  is  seldom  too  late  to 
try  and  administer  to  the  failing,  organ  the  most  potent  of  all 
remedies,  the  human  blood  of  the  patient  himself,  made  healthy 
by  the  means  adopted,  and  flowing  in  continuously  by  its  natu- 
ral channels. 

I  remember,  when  I  was  physician  to  St.  Mary's,  talking  in 
the  wards  to  the  pupils  on  this  subject  (as  was  my  frequent 
habit)  when  we  came  upon  a  new  patient,  an  undergrown  and 
undeveloped  girl,  the  mitral  orifice  of  whose  heart  was  narrowed 
by  rheumatic  inflammation  in  childhood.  On  her  being  carried 
into  the  hospital,  her  face  was  like  that  of  a  corpse,  and  she 
could  not  stand  without  fainting.  I  presume  no  sane  student 
expected  to  see  means  used  for  the  dilatation  of  that  valve, 
whose  contraction  was  the  source  of  evil :  despair  was  not  an 
illogical  conclusion  from  the  diagnosis  I  dictated  to  the  clinical 
clerk,  and  I  was  but  little  surprised  to  hear  behind  my  back 
the  remark,  "This,  at  all  events,  is  not  much  of  a  case  for  treat- 
ment." Yet  observation  of  the  functional  state  of  the  alimen- 
tary canal,  indicated  by  the  cedematous  tongue  and  fauces,  made 
me  improve  the  opportunity  by  expressing  an  opinion  that  she 
would  "  walk  home  with  color  in  her  cheeks."  A  month  after- 
wards I  was  able  to  say,  at  a  clinical  lecture  on  the  case,  "This 
she  has  been  able  to  do,  and  the  better  nourished  heart  now 
beats  steadily  and  evenly ;  though  its  mitral  orifice  is  as  small 
as  ever,  if  the  ear  and  stethoscope  are  to  be  trusted." 

And  not  once,  but  almost  weekly,  have  I  demonstrated  to  the 
same  class,  with  respect  to  many  a  consumptive,  how  little  it 
helped  us  to  know  that  half  of  the  upper  lobe  of  each  lung  was 
filled  with  crude  tubercles :  pulmonary  remedies  had  been  of  no 
benefit ;  but  the  reflection  that  the  stomach  was  secreting  an 
excess  of  mucus  at  the  same  time  with  the  lungs,  led  to  effectual 
means  for  the  relief  of  both  together. 

In  the  following  chapters  I  intend  the  sketches  I  give  of 
morbid  phenomena,  and  the  simple  classes  into  which  I  divide 
the  indigestions,  to  apply  equally,  whether  they  are  alone,  or 
whether  they  are  united  to  obvious  and  more  fatal  organic 
changes. 


INTRODUCTION.  25 


SECTION    II. 

There  is  no  pedantry  in  definitions  when  their  object  is  to 
lead  the  writer  and  reader  better  to  understand  one  another. 
So  I  shall  not  shrink  from  a  charge  of  over-precision  when,  the 
first  time  I  use  in  the  following  pages  a  word  capable  of  vari- 
ous interpretation,  I  often  stop  to  say  what  I  mean  by  it.  And 
at  the  present  stage  of  the  volume  let  us  not  grudge  a  few 
s  to  dividing  the  subject,  assigning  it  a  nomenclature,  and 
trying  to  turn  that  nomenclature  to  practical  profit. 

llKAi/niY  digestion  is  quick,  complete,  and  easy.  There  can 
be  no  excess  of  it,  for  food  cannot  be  too  quickly  and  com- 
pletely converted  into  chyme  and  taken  into  the  blood,  and 
there  is  no  such  thing  as  too  much  health  and  bodily  comfort. 

In  ILL  HEALTH  digestion  is  impaired  in  one  or  more  of  these 
qualities — it  becomes  slow,  defective,  &ndpainfnL 

We  may  use  Greek  words,  and  call  the  above-named  erring 
qualities  of  the  digestion  Bradypepsia,  Apepsia,  and  Dyspepsia; 
only  let  it  be  remembered,  that  making  the  old  adjectives  into 
new  substantives  adds  no  one  whit  to  our  knowledge — nay, 
unless  care  be  taken,  runs  some  risk  of  being  a  stumbling-block 

-  progress.     For  when  we  have  in  this  way  given  a  proper 
name  with  a  capital  letter,  we  are  apt  to  think  (like  a  naturalist 
with  a  new  butterfly)  that  we  have  defined  an  individual  and 
active  motive  power,  instead  of  what  is  really  the  deficiency  of 
a  function.     And  thus  we  fall  into  the  errors  of  our  forefathers, 
whose  efforts  to  destroy  their  abstract  foe  the  "  Disease,"  in- 

of  restoring  the  existing  patient,  led  to  so  much  bad  practice  in 
the  generation  now  passing  away.  I  shall  generally  use  the 
English  adjectives,  but  first  I  will  say  shortly  what  I  mean  by 
them  in  this  connection. 

By  digestion  being  slow  I  mean  that  the  act  in  some  part  of 
the  alimentary  canal  is  not  completed  by  the  time  when  the 
convenience  of  the  individual  requires  that  it  should  be  < 

•  I.     The  stomach  may  retain  so  much  of  a  former  meal 
that  it  is  not  in  a  fit  state  to  receive  the  new  one  which  is  need- 
ful for  the  sustenance  of  the  body.     Hence  arisr<  a  want  of  the 
natural  appetite    and    (when    it    is    long   continued)  imperfect 
nutrition,  an;emia,  debility,  &c.     Or,  if  we  attempt  to  force 


26  INTRODUCTION. 

food  too  quickly  on  the  unwilling  stomach,  we  have  chemical 
decomposition  and  defective  digestion  as  consequences. 

The  average  time  by  which  the  stomach  should  have  natu- 
rally emptied  itself  varies  in  different  healthy  persons  from  two 
to  four  hours.  The  intestines  have  extracted  all  that  they  are 
capable  of  absorbing  in  eight  or  nine  hours ;  and  the  relics  of 
complete  digestion  are  ready  for  expulsion  from  a  vigorous 
young  person  in  twenty-four  hours. 

By  defective  digestion,  I  would  imply  that  food  capable  of 
nourishing  the  body  cannot  do  so  from  lack  of  certain  changes 
which  it  should  naturally  undergo  in  the  alimentary  canal.  It 
is  passed  from  thence  either  unaltered  or  chemically  decom- 
posed. There  are  seen  in  the  feces,  either  by  the  naked  eye  or 
the  microscope,  masses  of  starch,  muscular  fibre,  fat,  &c.  I 
have  several  times  had  them  brought  to  me,  under  the  idea  that 
they  were  worms,  pieces  of  intestine,  or  other  foreign  bodies. 
Or  else  the  products  of  their  decay,  consisting  of  various  ob- 
noxious gases  and  acids,  are  developed  in  a  quantity  subversive 
of  social  comfort. 

Painful  digestion  may  be  both  defective  and  slow ;  but,  on 
the  other  hand,  it  not  unfrequently  also  is  complete  and  per- 
formed with  sufficient  quickness.  All  that  it  is  intended  to 
express  by  the  word  is  its  accompaniment,  at  some  stage  of  its 
progress,  by  feelings  varying  from  slight  discomfort  to  absolute 
agony. 

A  few  days  ago  a  patient  depicted  to  me  very  well  the  first- 
named  sensations  by  saying,  in  answer  to  the  question  whether 
he  had  any  pain,  no,  but  that  he  felt  where  his  stomach  was, 
and  knew  where  his  food  went  to.  And  on  the  other  hand  I 
have  heard  the  consequences  of  an  ordinary  meal  described  by 
a  theologian  (who  ought  to  know)  as  "the  tortures  of  the 
damned." 

A  very  practical  division  of  cases  of  indigestion  is  derived 
from  the  substance  which  is  indigested,  namely,  which  of  the 
chief  constituents  of-  the  diet,  whether  (1)  Starchy  and  Saccha- 
rine, (2)  Albumenoid,  (3)  Fatty,  or  (4)  Watery  food  most  exhibits 
the  failure  of  the  function.  This  is  to  be  learnt  partly  from  the 
patient,  and  partly  from  observation  of  the  consequences  which 
ensue  to  the  alimentary  mass.  On  it  is  grounded  an  important 


INTRODUCTION-.  27 

part  of  the  treatment,  namely,  the  dietetic;  and  as  its  indica- 
tions are  simple  as  well  as  valuable,  it  will  come  first  under 
consideration. 

A  very  essential  step  in  the  cure  of  indigestion  consists  in 
the  removal  of  its  external  causes,  where  these  are  removable. 
Til--  liillowing  chapter  therefore  will  be  on  "Social  Ilabits,"  by 
which  I  mean  causes  dependent. on  the  patient's  will.  There  is 
one  obvious  practical  distinction  between  these  and  other  causes, 
namely,  that  the  discovery  of  them  is  the  true  cure.  You  may 
bid  a  man  cease  from  over-eating,  over-fasting  or  smoking,  but 
you  cannot  bid  him  cease  from  being  poor  or  sorrowful,  from 
having  tubercles  in  his  lungs  or  an  ulcer  in  his  stomach. 

The  symptoms  of  these  errors  of  the  function  may  be  divided 
according  to  the  period  of  digestion  at  which  they  occur ;  some 
being  exhibited  before  the  alimentary  mass  has  left  the  stomach : 
some  during  its  way  along  the  intestines ;  some  after  the  passage 
of  the  ilio-cajcal  nerve. 

Now,  remark,  I  avoid  calling  these  phenomena  diseases  of  the 
salivary  or  gastric  glands,  of  the  intestines,  or  of  the  colon. 
They  are  not  so,  and  must  not  be  treated  as  such.  The  discom- 
forts felt  soon  after  a  meal,  for  example,  may  be  due  to  organs 
far  away  from  the  stomach — to  the  uterus,  to  the  kidneys,  to 
the  lungs — yet  they  must  be  called  by  the  same  names  as  when 
they  are  owing  to  anatomical  changes  in  that  part.  So  those 
occurring  later  often  are  traceable  not  to  anything  wrong  in 
the  duodenum,  ilia,  or  colon,  but  to  excess  of  gastric  mucus  or 
deficiency  of  pepsine. 

Let  it  be  understood  then,  that,  when  I  speak  of  theirs/  stage 
of  digestion  I  mean,  before  the  food  has  passed  the  pylorus ;  by 
the  second  stage,  its  transit  along  the  small  intestines ;  by  the 
////'/v/  stage,  all  that  takes  place  beyond  the  ilio-caecal  valve. 

These  phenomena  almost  always  require  separate  treatment 
of  themselves  in  addition  to  the  general  condition  from  which 
they  originate.  Indeed  they  are  such  a  prominent  part  of  the 
ailment  that  some  writers,  with  a  considerable  show  of  re; 
have  divided  indigestions  according  as  one  or  other  of  them  is 
the  distinguishing  features,  as  for  instance  M.  Chomel  does  into 

•</'',   '///>7"  •/v//;//Y'//',   (A/ty»y.x/-!  loHlt'i,. 

dy*2  'V,"  &c>     There  is  a  certain  amount  of  convein 


28  INTRODUCTION. 

in  this  in  respect  of  very  marked  cases :  the  worst  of  it  is  that 
many  invalids  exhibit  several  of  the  name-giving  symptoms  all 
at  once  in  equal  degrees,  and  it  is  difficult  to  assign  them  their 
due  place:  while  in  some  the  dyspepsia  (or  rather  the  patient) 
is  flatulent  one  day,  gastralgic  another ;  at  one  time  has  acidity 
in  excess,  at  another  alkalinity.  I  have  thought  it  better  there- 
fore in  this  treatise  to  discuss  each  symptom,  separately  where 
it  requires  separate  treatment,  or  in  groups  of  several  together, 
where  the  pathology  and  therapeusis  admit  of  union.  These 
will  fill  the  succeeding  chapters. 

Let  it  be  understood  that  I  speak  of  "Heart-burn,"  "Acidity," 
"  Vomiting,"  &c.,  in  these  chapters  as  diseases  independent  of 
the  cause  from  whence  they  arise;  referring  them  indeed  to 
that  cause  where  it  is  known,  but  not  placing  them  in  a  separate 
class  where  it  is  unknown. 

A  chapter  on  the  influence  exercised  by  the  functional  de- 
rangements of  the  digestive  viscera  over  the  nervous  system 
will  conclude  the  volume; 


29 


CHAPTER   II. 

INDIGESTION  OF  VARIOUS  FOODS. 

SECTION  1. — Defects  of  digestion  as  exhibited  in  Starchy  and  Saccharine  food. 
ON  2. — In  Albuminoid  food.     SECTION  3. — In  Fatty  food.     SECTION  4. — In 
Watery  food.     SECTION  5. — Treatment  based  on  articles  indigested.     SECTION 
6. — Treatment  based  on  pathological  condition. 

SECTION  I. 
Indigestion  of  Starch  and  of  Sugar,  or  Vegetable  Food. 

Ix  its  original  condition,  either  raw  or  when  broken  up  by 
boiling,  it  does  not  appear  that  starch  is  capable  of  being 
absorbed  by  the  alimentary  canal.  But  on  its  first  introduction 
nt  the  mouth  it  meets  with  a  fluid  capable  of  converting  it  into 
one  of  the  most  absorbable  of  alimentary  substances:  indeed  its 
change  into  sugar  by  the  saliva  may  be  fairly  regarded  as  its 
ng  to  be  a  part  of  a  plant  and  becoming  a  food.  The 
reduction  of  it  makes  it  into  a  complementary  food  duly  repre- 
sented in  our  type  of  a  perfect  diet,  milk,  by  its  peculiar  form 
of  saccharine  matter  "sugar  of  milk." 

This  metamorphosis  begins  immediately  with  the  introduc- 
tion of  the  morsel  into  the  mouth,  and  is  almost  instantaneous 
in  all  parts  with  which  it  is  brought  into  contact  by  the  action 
of  chewing.  A  good  deal  of  the  secretion  is  carried  down  into 
the  stomach  and  continues  its  influence,  though  much  retarded 
1)\  the  necessary  acidity  of  the  gastric  juice.  Should  any  of 
-larch  granules  have  escaped  rupture,  or  if  it  be  eaten  raw, 
the  gastric  juice  (if  strong)  dissolves  the  albuminoid  envelope, 
and  sets  some  more  amylaceous  mutter  free.  When  the  mass 
pa.-.-es  through  the  pylorus  its  acidity  is  neutralized,  the  action 
of  the  remaining  saliva  recommences  on  the  starch  yet  uncon- 
vrrted  or  lately  set  free.  ;  ami  tin-  action  is  reinforced  by  the 
pancreatic  juice. 


30  INDIGESTION    OF    VARIOUS    FOODS. 

Of  the-sugar  made,  a  very  great  part  is  absorbed  in  the  mouth, 
and  gullet,  sometimes  all  of  it,  for  chemists  have  great  difficulty 
in  finding  sugar  in  the  stomach.  The  most  essential  part  of  the 
digestion  of  vegetable  food  is  doubtless  the  osmosis  of  the  sugar 
through  the  mucous  coat  of  the  alimentary  canal.  A  great  part 
of  the  excess  is  converted  into  lactic  acid  to  aid  in  the  solution 
of  flesh  food,  and  the  rest  is  taken  up  by  the  intestines. 

For  the  reduction  of  starch,  then,  so  as  to  bring  it  into  a  con- 
dition capable  of  digestion,  it  is  necessary,  first,  that  the  salivary 
glands  should  secrete  a  sufficiency  of  fluid  suited  to  convert  it 
into  sugar ;  and  that  not  only  at  the  moment  of  chewing,  but 
that  they  should  go  on  supplying  it  as  long  as  any  starch  remains 
unconverted.  Now,  the  salivary  glands  are  more  exposed  to 
derangement  by  circumstances  external  to  themselves  than  any 
organ  not  directly  subject  to  the  will.  Temporary  emotion 
affects  them  temporarily,  and  continued  emotion  affects  them 
chronically.  "We  all  know  the  dry  mouth  of  the  coward,  the 
lover,  the  pitiful,  and  how  the  tongue  clings  to  the  roof  when 
bad  news  is  brought.  We  see  too  how  for  days,  or  even  for 
weeks,  "  bread  eaten  in  sorrow"  can  hardly  be  swallowed,  so 
long  it  takes  to  moisten  the  morsel.  Even  in  the  healthiest 
person  bodily  exertion  parches  the  throat.  Again,  there  is 
scarce  any  morbid  condition  that  does  not  make  itself  felt  in 
the  fauces  and  seen  in  the  tongue.  Numerous  analyses  of  the 
saliva  in  inflammatory,  and  in  other  affections  which  seem 
remote  (such  as  uterine  disease,  phthisis,  chlorosis,  ague),  show 
that  the  changes  are  marked  enough  to  be  detected  by  chemical 
examination.1  These  changes  are  all  in  the  direction  pointing 
to  want  of  vitality  :  either  the  animal  constituents  are  deficient, 
producing  a  watery  saliva ;  or  they  are  turned  sour  or  putrid 
by  decomposition.  It  was  to  have  been  expected,  therefore 
that  all  defects  of  general  vitality  should  give  rise  to  them. 

Besides  the  saliva,  another  digestive  secretion  practically 
comes  into  play  in  the  solution  of  starch,  to  wit,  the  gastric  juice. 
Cookery,  even  when  most  efficient,  rarely  ruptures  the  whole 
of  the  amilaceous  granules.  Many  escape  in  the  best,  and  in 

1  They  may  be  found  in  Simon's  "Chemistry,"  vol.  ii.  p.  9  (Sydenham 
Society's  Translation). 


INDIGESTION    OF    VARIOUS    FOODS.  31 

bad  cookery  the  majority  escape.     They  cannot,  therefore,  be 

<:d  by  the  saliva,  till  their  albuminous  envelope  has  been 

Ived  by  the  gastric  juice.     Then  they  may  be  converted 

into  grape  sugar,  either  rapidly  by  the  saliva  present,  or  more 

slowly  by  the  pancreatic  and  other  intestinal  secretions. 

The  digestion  of  amylaceous  and  saccharine  matters  without 
inconvenience  requires  also  the  oesophagus  to  be  throughout  in 
a  normal  state ;  for,  as  before  remarked,  in  health  the  greater 
part  of  the  sugar  made  should  be  absorbed  before  it  arrives  at 
the  stomach.  In  the  lighter  cases  of  dyspepsia,  and  in  the  tem- 
porary dyspepsia  of  excess,  it  is  probably  this  power  which 
principally  fails;  and  the  consequent  symptoms  probably  arise 
from  the  presence  of  an  excess  of  sugar  thus  passed  on  and  apt 
to  ferment  in  the  intestinal  canal. 

Requiring  so  much,  and  so  much  that  is  soon  affected  by 
outward  circumstances,  the  digestion  of  starchy  food  may  be 
easily  understood  to  suffer  the  first,  the  most  completely,  and  the 
commonly.  Let  us  take  as  an  example  the  simplest  of  all 
forms  of  deficient  vitality,  the  consequences  of  an  imperfect 
supply  of  that  which  vitality  most  requires  for  its  manifestation, 
allmrnenoid  food  and  pleasurable  emotion.  How  familiar  is 
such  a  case  as  the  following,  upon  which  I  fall  on  turning  over 
only  a  very  few  leaves  of  my  hospital  note-book ! 

I.— Caroline  P — ,  aged  49,  a  musician's  widow,  who  formerly  with 
her  husband  earned  an  easy  subsistence  by  her  profession,  had  been  for  a 
year  living  (as  she  called  it)  on  needlework  and  looking  on  life  with  despair. 
On  JUT  ad  mission  to  St.  Mary's  in  April,  1860,  she  is  described  as  a  long-faced 
c:n  hectic  woman  with  sharp  features,  thin  lips  and  hair  still  brown.  II-  r 
complaint  was  of  pain  and  an  intolerable  feeling  of  weight  at  the  epigastrium 
coming  on  an  hour  after  eatinjr.  flatulence1  either  breaking  off  from  the  mouth 
or  aftenvanls  distending  the  abdomen.  So  that  she  almost  dreaded  to  take 
food.  Hut  what  was  this  food?  liread,  potatoes,  tea,  sometimes  a  bit  of 
bacon,  hardly  ever  a  hit  of  meat.  However,  she  had  got  not  to  care,  eating 
at  all  was  so  distasteful  to  her.  When  ordered  two  meals  of  fresh  meat  daily, 
she  could  not  indeed  at  first  relish  it  without  half  a  glass  of  port  wine  to  wash 
it  down.  But  that  disrelish  soon  passed  away.  In  a  fortnight  she  had  re- 

1  By  "  flatulence"  I  mean  the  superabundant  collection  of  gas  in  the  alimen- 
tary canal,  whether  it  pass  aw;iy  upwards  or  downwards,  or  reiuaiu  iu  the 
abdomen. 


32  INDIGESTION    OF    VAKIOUS    FOODS. 

covered  her  appetite,  and  moreover  was  able  to  take  even  vegetable  food.    In 
another  week  she  was  well  enough  to  leave  the  hospital. 

Gastric  juice  is  required  to  rid  the  digestion  of  starch  by  dis- 
solving the  albuminous  envelopes  of  the  granules:  gastric  juice 
is  a  highly  animalized  fluid ;  to  make  it  animalized  fresh  blood 
is  a  sine  qud  non:  and  the  material  of  which  that  is  quickest 
made  is  meat  food.  Such  is  the  rationale  of  these  satisfactory 
cases. 

"Where  the  starvation  and  consequent  anaemia  fall  by  accident 
on  a  patient  less  acclimatized  by  gradual  grinding  inevitable 
poverty  to  them,  they  produce  symptoms  not  probably  more 
fatal,  but  more  marked  and  more  painful  to  the  sufferer.  For 
the  nervous  system  retains  its  sensitiveness — its  instinctive 
courage,  as  it  were — and  complains  loudly  of  the  partial  death 
forced  upon  it.  Here  is  an  example,  illustrative  of  a  more 
sensitive  indigestion  also  following  inanition. 

CASE  II. — Mr.  V — ,  aged  50,  a  periodical  writer,  usually  well  paid  and 
usually  healthy,  from  loss  of  employment  during  the  spring  and  summer  of 
1866  was  reduced  to  great  straits,  and  for  long  periods  at  a  time  had  barely 
enough  food  to  keep  body  and  soul  together.  After  a  time  he  ceased  to  feel 
hunger,  and  the  principal  warning  he  had  of  starvation  was  the  feeling  of  an 
extraordinary  lack  of  muscular  power.  He  did  not  perceive  his  intellectual 
energies  flag  at  all.  After  he  got  into  luck  again  he  found  it  impossible  to 
take  advantage  of  the  plenty  poured  around  him.  Eating  anything  was 
followed  in  ten  minutes  or  a  quarter  of  an  hour  by  intense  pain  in  the  epigas- 
trium extending  downwards  over  the  hypogastric  region.  The  sensation  was 
"  as  if  the  navel  were  gripped  with  an  iron  hand."  The  mildest  liquids,  such 
as  tea,  brought  on  this  agony  quite  as  much  as  the  most  insoluble  viands  or 
strongest  stjraulants.  He  was  much  troubled  with  flatulence  after  vegetables, 
both  upwards  and  downwards.  Meat  did  not  indeed  induce  so  much  flatulence, 
but  its  ingestion  was  followed  almost  immediately  by  the  intense  pain  at  the 
epigastrium.  If  he  could  bear  this,  he  digested  it  pretty  completely.  Then 
he  noticed  how  emaciated  he  grew,  so  that  the  balance  testified  to  a  loss  of 
two  stone  of  flesh.  He  was  not  conscious  of  this  during  the  starvation.  Now, 
too,  he  became  sensible  of  a  failure  of  mental  power,  especially  in  the  hours 
when  the  flatulence  oppressed  him  most.  "When  I  saw  him  in  October,  he 
presented  a  pitiable  aspect  of  distress  and  emaciation ;  his  abdominal  pain 
was  growing  worse  and  worse,  his  urine  was  of  extremely  low  specific  gravity 
(I  have  lost  the  note  of  the  exact  figure). 

I  prescribed  for  him  a  draught  of  Hydrocyanic  Acid  with  Battley's  Seda- 
tive Liquor  (four  minims  of  the  first  and  five  of  the  second),  to  be  taken  a 
few  minutes  before  each  of  the  daily  meals.  In  three  weeks'  time  he  came 


INDIGESTION    OF    VARIOUS    FOODS.  33 

to  report  favorable  progress.  He  had  gained  flesh,  lost  his  pain  in  a 
great  meusurf.  and  was  able  to  take  a  meal  often  even  without  the  aid  of  the 
draught.  Hut  In-  -till  had  some  degree  of  gaseous  distension  of  the  abdomen, 

•able  by  the  hand  and  eye;  still  his  brain  was  not  so  clear  for  work  as 
could  be  wished.  I  gave  him  my  usual  Quinine  and  Strychnine  mixture,  with 
three  minims  of  Hydrocyanic  Acid  and  a  grain  and  a  half  of  Iodide  of  Potas- 
sium, to  take  twice  a  day.  under  the  use  of  which  he  got  quite  strong  again. 

Observe  here  how  the  digestion  of  vegetables  was  slow  and 
<>v,  while  that  of  meat  was  only  painful.     For  the  cure 
was  a  needful  medicine,  and  therefore  the  first  thing  to  be 
done  towards  the  cure,  was  artificially  and  by  drugs  to  stay  this 
inconvenient  pain.    To  have  stayed  the  pain  without  supplying 
the  meat  would  have  been  merely  palliative  or  allopathic  treat- 
ment; to  make  the  anajsthesia  a  stepping-stone  to  the  formation 
of  gastric  juice  out  of  albuminous  food  was  strictly  restorative. 

The  Iodide  of  Potassium  in  the  last  prescription  was  designed 
to  promote  the  activity  of  the  salivary  glands.  I  have  found 
that  it  does  so  in  my  own  person,  and  it  has  seemed  to  me  that 
the  saliva  is  not  merely  increased  by  the  addition  of  water,  as 
the  urine  is  by  nitre  and  other  neutral  salts,  but  that  it  converts 
more  starch  into  sugar  by  the  augmentation  of  its  special  fer- 
ment. But  it  has  also  seemed  to  me  that  this  action  of  the 
Iodide  of  Potassium  was  a  very  temporary  one,  that  it  lasted 
but  a  few  days,  and  that  a  continuance  of  the  drug  could  not  be 
trusted  to  for  producing  a  continued  effect.  We  must  therefore 
it  just  at  the  right  moment,  and  not  waste  it  by  beginning 
too  soon  or  pushing  it  too  long. 

The  use  of  larger  doses  does  not  obviate  the  difficulty,  and  I 
therefore  do  not  give  them.  The  larger  dose  in  the  accompany- 
ing ease  was  given  lor  another  purpose. 

1 1 1. — Mr.  Wm.  S — ,  an  artist  of  middle  age,  was  my  patient  in  the 
autumn  of  lM»0  fur  •  f  doubtful  origin.     Among  other  experiments 

I  tried  the  effect  of  Iodide  of  I'ntassium  in  doses  of  thirty  grains  a  day.  It 
did  no  good  to  tin-  di.-raM-  of  the  skin  or  nails,  but  the  patient  at  first  took  a 
great  fancy  to  .  t  enabled  him,  he  said,  to  take  his  meals  of  mixed 

food  without  consequent  discomfort,    lie  could  digest  even  potatoes  and  beer, 
a  fortnight  or  so,  however,  he  was  forced  to  confess  that  his  stomach 
was  not  what  it  was  in  youth,  and  that  he  was  not  to  In-  exempted  from  the 
'•  care  for  his  meat  and  diet"  which  the  Son  of  Sirach  considers  chanu  ' 
of  a  good  man  of  intellect. 
3 


34  INDIGESTION    OF    VAEIOUS    FOODS. 

The  appetite  is  a  very  important  part  of  the  animal  functions. 
The  loss  of  it  is  familiarly  known  to  be  a  consequence,  but  it  is 
also  often  a  cause  of  bad  health.  And  the  mode  in  which  it 
affects  the  health  seems  to  be  by  diminishing  the  supply  of 
albumenoid  food,  and  so  indirectly  the  quantity  of  gastric  juice. 

CASE  IV. — In  November,  1861, 1  admitted  to  St.  Mary's  a  pleasing,  well- 
grown  girl  of  twenty,  named  Margaret  C .  She  was  extremely  pale,  and 

BO  weak  that  she  could  hardly  raise  herself  in  bed ;  yet  no  organic  disease  or 
pathological  state  of  any  of  the  solid  parts  of  the  body  could  be  discovered 
to  account  for  her  condition.  She  attributed  her  illness  to  the  close  smell  of 
a  workshop  in  which  she  had  been  employed,  which  spoiled  her  appetite, 
making  her  at  first  crave  for  unwholesome  things,  and  reject  what  was  set 
before  her,  afterwards  destroying  the  desire  for  victuals  altogether.  She 
observed  it  did  not  seem  to  make  the  other  apprentices  ill,  who  were  not  so 
squeamish.  Perhaps  the  accident  of  her  having  been  more  tenderly  nurtured, 
and  so  more  sensitive  than  her  companions — perhaps  the  responsibility  of 
being  placed  over  them  as  forewoman — contributed  to  this  result.  The  end 
was,  that  the  loss  of  appetite  induced  anaemia,  swelled  ankles,  amenorrhcea, 
and  a  certain  amount  of  hysteria.1  Then,  though  removed  from  the  original 
cause  of  the  disease,  she  took  a  disgust  to  all  articles  of  food,  complained 
that  vegetables  especially  produced  flatulence,  and  had  to  come  into  the 
hospital,  she  was  so  weakened.  When  put  npon  the  diet  of  milk  and  Liquor 
Calcis  every  two  hours,  with  a  pint  of  beef-tea  in  divided  doses  daily,  she 
digested  it  without  inconvenience,  but  at  first  without  relish.  After  two  days 
she  was  able  to  take  an  egg,  and  after  twelve  days  of  gradual  additions  of  this 

1  Dr.  Reynolds  remarks,  in  the  Introduction  to  his  System  of  Medicine,  that 
"  by  '  hysteria'  is  conveyed  some  meaning  or  none  at  all,  and,  when  the  former, 
a  meaning  as  various  in  character  as  are  the  individuals  who  use  the  word."  I 
take  this  opportunity  of  saying  that  by  it  I  intend  no  reference  to  the  womb 
(urTfpa),  from  which  the  Greeks  derived  the  word  in  deference  to  a  false  theory 
of  its  origin  ;  which  unfortunate  derivation  often  leads  to  a  bad  practice.  By  it 
I  mean  a  peculiar  state  of  the  individual  in  which  the  emotions  exercise  a  sway 
over  the  functions  of  mind  and  body  usually  subject  to  voluntary  control,  and 
produce  spasmodic  contractions  and  paralysis  of  involuntary  muscles. 

Its  pathology  must  be  sought  for  in  that  puzzling  part  of  the  circle  of  life 
which  lies  between  spirit  and  matter.  We  know  so  little  about  the  chain  which 
connects  the  two,  that  its  links  are  reckoned  by  us  as  few  and  short,  we  have 
no  names  for  any  of  them  ;  and  in  default  of  names  for  even  the  healthy  func- 
tions, we  must  not  expect  an  accurate  nomenclature  for  their  aberrations.  So 
that  the  most  we  can  do  in  trying  to  classify  forms  of  hysteria  is  to  trace  how 
near  their  origin  lies  to  one  or  other  extremity  of  the  series  of  vital  actions  which 
are  interfered  with  ;  what  relation  their  phenomena  bear  on  the  one  hand  to 
mind  ;  and  what  on  the  other  to  body.  We  shall  thus  have  set  in  a  natural 
series  the  varieties  of  the  disease,  with  pure  insanity  at  the  one  end,  and  epilepsy 
traceable  to  organic  lesion  at  the  other. 


INDIGESTION    OF    VARIOUS    FOODS.  35 

sort  she  arrived  at  the  full  allowance  of  "  ordinary  diet" — mutton,  porter, 
;i.  mill  milk.   She  lost  her  flatulence,  and  soon  picked  up  her  good  looks. 
For  medicine  she  had   Iron   three  times  a  day,  and  pills  of  Aloes  and 
Myrrh,  at  first  every  night,  afterwards  not  so  often. 

In  a  clinical  lecture  given  at  the  time  I  laid  the  condition 
of  the  patient  at  the  door  of  the  digestive  canal.  The  circum- 
stances to  which  I  have  traced  the  illness  act,  directly  or  indi- 
rectly, both  on  this  part.  In  the  first  place  the  mental  exertion 
involved  in  an  untoward  responsibility  thrown  on  a  conscien- 
tious person  would  lessen  the  life  of  the  involuntary  muscles 
which  carry  along  the  mass  of  food  through  the  alimentary 
canal.  We  know  well  how  heavy  pur  food  lies  in  our  stomach 
if  culled  to  a  serious  case  just  after  a  hearty  meal ;  how  long  it 
is  in  leaving  it,  and  how  enervated  the  parietal  muscles  feel. 
Then  at  the  same  time  that  mental  causes  thus  slackened  the 
mechanics  of  nutrition,  the  unwholesomeness  of  the  air  in  the 
close  shop  where  the  patient  was  employed  poisoned  the  mu- 
cous membranes,  diminishing  the  vitality  of  the  epithelium, 
and  causing  them  to  be  abnormally  covered  with  a  thick  layer 
of  mucus.  By  this  tenacious  coating  the  entrance  of  alimen- 
tary substances  into  the  veins  and  absorbents  was  impeded,  and 
the  owner  pined  in  the  midst  of  plenty.  So  all  the  usual  signs 
of  starvation  followed.  First  irregular  hunger — by  no  moans 
a  constant  companion  of  chronic  deprivation  of  food,  yet  some- 
times present  as  here;  then  loss  of  appetite — a  much  more 
frequent  phenomenon;  then  paleness,  languor,  weariness;  then 
anasarcous  oedema,  and  all  the  other  more  marked  symptoms  of 
anaemia  in  their  order. 

The  deficiency  of  digestive  power  was  exhibited  principally 
in  respect  of  potatoes,  pastry,  sugar,  porter,  all  of  which  pro- 
duced ilatulence  and  pain  at  the  epigastrium,  and  wore  hi 
sequence  at  first  omitted  from  the  dietary.  She  digested  easily 
i'n>m  the  beginning  small  quantities  of  milk  and  bool'-toa.  It  is 
obvious  that  if  I  had  written  down  ever  so  many  "full  diets," 
one  to  whom  the  very  sight  of  food  was  an  abomination  would 
have  gained  nothing  by  it;  she  would  simply  have  gone  with- 
out oaeh  meal.  So  I  directed  no  meals  at  all  to  be  taken,  and 
no  solid  food  ;  but  a  cup  of  milk  with  a  third  part  of  lime-v 
in  it  to  be  given  us  medicine  every  two  hours,  and  a  p: 


36  INDIGESTION    OF    VARIOUS    FOODS. 

beef- tea  in  divided  doses  during  the  day.  I  remarked  to  the 
students  that  our  object  must  be  to  make  the  patient  a  carni- 
vorous animal  in  order  to  make  her  omnivorous. 

After  a  short  time,  shorter  perhaps  than  one  can  always  hope 
for,  the  selected  nitrogenous  food  restored  the  digestive  juices 
to  their  full  powers,  and  she  was  able  to  take  without  pain,  even 
the  most  difficult  to  digest  of  all  aliments,  a  hospital  potato. 

Sometimes  the  condition  which  originates  the  indigestion  is 
an  organic  and  incurable  degeneration.  Yet  in  spite  of  the 
persistent  cause  growing  of  course  worse  and  worse,  the  indi- 
gestion may  not  proceed  beyond  that  of  starch.  For  instance, 
Bright's  disease  of  the  kidneys  may  have  this  effect. 

CASE  V. — Maria  R — ,  aged  52,  had  suffered  for  four  winters  from  cough  and 
shortness  of  breath,  which  went  away  when  the  weather  became  mild.  Her 
appetite  was  generally  good,  and  she  did  not  suffer  from  indigestion.  In  the 
spring  of  1861,  as  she  got  better  from  her  winter  attack,  she  found  she  could 
not  get  about  from  swelling  of  the  legs.  This  anasarca  grew  worse,  she  got 
ascites  as  well,  and  came  into  St.  Mary's.  The  urine  was  found  to  be  albu- 
minous. It  was  not  till  she  had  been  in  the  ward  above  a  week  that  she  com- 
plained of  bad  nights  from  flatulence,  and  a  sensation  of  fulness  in  the  epigas- 
trium, which  shortly  after  dinner  became  pain.  Hydrocyanic  Acid  and  Soda 
did  not  relieve  this,  but  the  change  from  ordinary  diet  to  fish  without  potatoes 
did  so  immediately.  The  patient  remained  in  the  hospital  more  than  three 
months,  for  abscesses  and  sloughs  formed  in  the  cellular  tissue  of  her  legs 
from  distension,  and  she  was  a  long  time  on  a  water-bed.  She  finally  got  well 
enough  of  the  dropsy  to  be  discharged,  but  never  was  able  to  digest  well, 
though  no  more  severe  symptoms  were  produced  than  those  detailed. 

Of  a  more  common  form  of  the  dyspepsia  accompanying 
albuminuria  I  find  an  instance  a  few  pages  further  on  in  the 

case-book. 

• 
CASE  VI. — Frances  S. — ,  aged  63,  a  superannuated  governess,  was  admitted 

June  7,  1861,  with  general  dropsy  of  three  weeks'  duration,  dependent  on 
albuminuria.  She  had  for  some  time  suffered  a  good  deal  from  flatus,  occur- 
ring soon  after  meals,  and  followed  by  vomiting  of  the  ingesta.  When,  for  a 
few  days  from  time  to  time,  the  victuals  were  retained,  griping  and  diarrhosa 
were  often  the  consequence. 

In  these  sort  of  cases  it  is  to  be  observed  that  the  symptoms 
are  much  more  severe,  not  confined  to  amylaceous  food,  and 
producing  the  phenomena  of  vomiting,  which  will  be  a  matter 


INDIGESTION    OF    VARIOUS    FOODS.  37 

for   future   consideration.     If  vomiting   fails   to   be  producd, 
diarrhoea  often  '  place. 

1'isease  of  the  heart  produces  sometimes  a  very  marked  indi- 
>n.     This,  I  think,  mostly  occurs  where  it  is  aggravated  by 
an   atonic   condition   of  the   arteries,  so   that   the  abdominal 
circulation  is  especially  obstructed. 

CASE  VII. — Mr.  James  L — ,  aged  63,  came  under  my  care  March  llth, 
He  h;ul  for  a  year  past  been  growing  very  wheezy  and  short-winded. 
On  examination  of  the  heart,  it  exhibited  a  tumbling  action;  its  stroke  was 
uneven  and  irregularly  intermittent;  the  sounds  were  distant  and  not  accom- 
panied by  morbid  murmur.  The  pulse  at  the  wrist  was  more  irregular  and 
intermittent  than  the  heart.  The  urine  was  albuminous,  of  the  spec.  grav. 
1  .nits  when  warm  from  the  bladder,  and  was  free  from  tube-casts  after  standing. 
For  the  last  few  weeks  he  had  been  unable  to  sleep  at  nights,  suffering  much 
from  flatulence.  This  did  not  arise  from  overloading  the  stomach,  for  his 
appetite  was  gone.  The  skin  had  become  yellower  than  usual,  indeed  the 
yellowness  of  his  complexion  was  visible  through  the  fixed  russet-apple  tint  of 
hearty  old  age  which  appeared  in  his  cheeks.  I  prescribed  two  grains  of  Aloes 
ami  Myrrh  pill  ever)'  night,  and  two  tablespoonfuls  twice  a  day  of  the  follow- 
ing mixture: — 

R. — Ferri  et  Quinise  Citratis,  gr.  40. 
Tincturae  Digitalis,  £  fl.  oz. 
-1  Jheris,  £  fl.  oz. 
Aquae,  fl.  oz.  15. 

On  the  19th,  he  said  he  was  twice  the  man  he  was  in  both  breath  and 

bowels.     And  indeed  he  looked  so,  for  the  skin  was  clearer,  his  appetite  and 

were  better,  and  the  pulse  was  nearly  regular.     The  urine  was  1.015  in 

i-p.  irrav.,  but  still  albuminous.     So  that  all  improvement  was  traceable  to 

the  heart,  not  to  the  kidneys. 

The  amelioration  in  this  case  seemed  due  to  the  tonic  action 
of  the  Digitalis  on  the  arteries,  combined  with  the  arteriali/a- 
tion  of  the  blood  by  Iron. 

Sometimes  the  organic  disease  producing  amylaceous  dyspep- 
sia is  not  one  of  t  -ue-cluin^es  which  are  capable  of  ana- 
tomical demonstration,  and  with  which  we  are  familiar  from 
urns  and  drawings,  but  those  more  recondite  alterations  in 
the  nervous  system  which  are  provisionally  termed  functional. 
For  example 


CASE  VIII. — James  L — ,  a  bricklayer,  aged  32,  was  admitted  to  8 
under  my  care  in  August,  1857,  principally  for  a  loss  of  power  and  of  sensi- 


38  INDIGESTION    OF    VARIOUS    FOODS. 

bility  in  the  legs,  due  to  some  extraordinary  exertion  six  weeks  previously. 
Besides  this  he  complained  of  pain  at  the  epigastrium,  not  increased  by  pres- 
sure, but  only  by  taking  food.  His  tongue  was  dryish  and  white,  his  pulse 
feeble.  When  this  was  observed,  potatoes  were  omitted  from  his  dietary, 
which  had  previously  contained  them,  and  the  discomfort  ceased.  He  after- 
wards had  Quinine  and  full  meat  diet,  with  an  extra  allowance  of  bread  to 
"take  the  place  of  potatoes,  and  remained  in  hospital  altogether  three  weeks, 
without  any  return  of  the  epigastric  pain. 

Here  subtraction  of  diet  was  possible  and  effectual,  and  its 
effect  confirmed  the  diagnosis.  Potatoes,  as  usually  cooked,  are 
probably  the  most  objectionable  article  of  food  which  can  be 
presented  to  a  weak  digestion.  The  starch  granules  are  but 
half  ruptured,  and  are  held  together  by  cellular  tissue,  so  that 
they  are  reduced  by  mastication  only  into  small  pellets,  which 
require  long  soaking  in  gastric  juice  before  they  can  be  broken 
up.  Mashing  them  expedites  this  process  very  much,  but  even 
then  a  good  deal  escapes  digestion.  Mixing  them  when  mashed 
with  meat  gravy  is  a  further  expedient  which  is  also  useful. 

The  relation  of  muscular  exhaustion  to  indigestion  was  inci- 
dentally alluded  to  in  the  last  case.  There  are  several  forms  of 
its  exhibition.  The  most  common  is  that  which  we  see  more  as 
members  of  general  society  than  as  physicians,  namely,  where 
in  a  healthy  person  some  extraordinary  exertion  brings  on  a 
temporary  inability  to  digest  all  food  more  or  less,  but  especially 
vegetable. 

CASE  IX. — A  healthy  young  woman,  after  being  on  horseback  eight  hours 
in  a  hot  sun,  first  took  a  short  nap,  and  then  sat  down  to  dinner,  of  which  she 
partook  moderately,  having  but  little  appetite.  In  the  evening  she  suffered 
much  from  tightness  across  the  chest ;  in  the  night  was  unable  to  sleep  for 
flatulence  coming  up  in  eructations,  and  rolling  about  the  bowels ;  she 
vomited,  went  to  sleep,  and  the  next  day  was  well. 

Sometimes  the  disturbance  proceeds  further — 

CASE  X. — In  1863,  during  my  autumn  holiday  in  Switzerland,  I  had  saun- 
tered up  from  Zermatt,  and  spent  the  afternoon  on  the  Riffelberg.  I  remember 
it  well,  for  it  is  the  last  Alpine  climb  I  shall  ever  have.  A  little  before  dinner 
I  was  joined  by  a  gentleman  whom  I  had  seen  some  days  before  stepping  out 
well  on  the  Theodule  glacier,  and  who  was  evidently  used  to  the  high  Alps. 
He  had  now  just  come  from  the  ascent  of  Monte  Rosa  in  a  shorter  time  than 
usual,  and  both  he  and  the  guides  confessed  to  being  tired.  He  dined  moder- 


INDIGESTION    OF    VARIOUS    FOODS.  39 

ately  well,  and  after  dinner  proposed  to  accompany  me  back  to  Zermatt.  We 
set  off  accordingly,  bat  long  before  we  arrived  at  our  destination  he  was  taken 
with  flatulence  and  eructations,  which  shortly  led  to  gripings  and  diarrhosa, 
with  extraordinary  explosions  of  wind.  I  felt  very  glad  that  darkness  had 
cleared  the  road  of  all  wayfaring  spectators,  and  that  we  had  a  guide  with  us. 
However,  we  got  down  all  right,  and  the  next  day  he  was  none  the  worse. 

Sometimes  the  diarrhoea  is  later  in  its  supervention — 

CASE  XI. — S.  G.  S — ,  after  a  tedious  ride  across  the  Sierra  in  Andalusia, 
vomited  a  luncheon  of  bread  and  cheese  which  he  had  eaten.  Feeling  a  want 
of  appetite  and  a  disgust  to  meat,  he  afterwards  dined  lightly  on  soup,  bread, 
and  vegetables.  In  the  night  and  next  morning  he  had  frequent  eructations, 
ami  in  the  afternoon  of  the  day  following  the  exertion,  griping  and  diarrhoea, 
with  much  flatulence.  Throughout  the  attack  the  urine  was  very  high- 
colored,  being  as  dark  as  porter,  though  not  scanty.  A  day's  rest  set  all  to 
rights. 

In  these  temporary  attacks  there  is  a  general  feverishness  of 
the  system,'  not,  indeed,  marked  by  rigors,  but  by  anorexia, 
high-colored  urine,  thirst,  and  dryness  of  throat.  They  are 
not  evidences  of  bad  health,  for  they  arise  only  in  consequence 
of  such  exertions  as  no  one  need  take  without  they  like.  But 
as  a  rule  I  doubt  if  such  violent  exercise  contributes  to  good 
health,  especially  in  middle-aged  persons,  and  it  is  not  a  wise 
employment  of  those  short  holidays  which  we  Londoners  can 
afford  ourselves. 

Another  form,  more  suited  for  medical  treatment,  is  where 
the  indigestion  of  starchy  food  recurs  habitually  after  even 
moderate  exertion,  an  exertion  such  as  does  not  tire  the  re- 
mainder of  the  body. 

CASK  XII. — John  E — ,  a  sturdy,  hard-featured  fox-hunter,  aged  73,  who 
had  lived  in  the  country,  farming  and  riding  to  hounds  all  his  life,  and  never 
been  ill  before,  came  to  me  in  November,  1863,  complaining  that  for  the  two 
months  past,  whenever  be  undertook  any  of  the  usual  exertion  entailed  by  his 
active  life,  he  was  overwhelmed  with  flatulence.  The  abdomen  swelled  up, 
and  he  passed  wind  first  upwards  and  then  downwards  ;  after  which  he  felt 
relief,  if  he  took  •rest,  lie  was  well  so  long  as  he  kept  quiet,  lint  each  fresh 
occasion  for  muscular  effort  brought  back  the  uncomfortable1  symptoms.  Pre- 
scribed (Quinine  and  Strychnine,  more  sedentary  habits  as  suitable  to  his  time 
of  life,  and  to  take  luncheon  and  late  dinners,  instead  of  a  heavy  midday  meal 
aud  high-tea,  as  his  custom  had  been. 


40  INDIGESTION    OF    VARIOUS    FOODS. 

In  this  instance  it  was  pretty  clear  that  the  defective  vital 
power  of  the  stomach  was  the  first  indication  of  approaching 
old  age,  and  was  a  warning  that  habits  more  suitable  to  that 
inevitable  event  must  be  adopted.  The  older  the  stomach  is, 
the  less  it  can  bear  either  long  abstinence  or  the  overloading 
which  is  consequent  thereon  in  a  person  of  active  pursuits. 

Sometimes  the  agency  which  brings  on  chronic  indigestion  is 
of  a  much  more  sudden  character. 

CASE  XIII. — "William  S — ,  aged  37,  came  to  me  August  1,  1861.  He  said 
that  ten  years  before  he  had  exerted  himself  violently  at  Epsom  on  the  Derby- 
day  in  hallooing  and  running.  He  was  suddenly  attacked  with  a  severe  stitch 
in  the  side  and  excessive  flatulence.  He  vomited,  and  that  temporarily 
carried  off  the  pain.  Before  that  period  his  digestion  had  always  been  per- 
fectly strong,  but  ever  since  he  has  suffered  from  eructations  of  tasteless  air 
from  the  stomach,  within  an  hour  after  meals.  Recently,  after  any  mental 
annoyance,  he  had  had  attacks  of  vomiting.  Latterly,  too,  his  general  health 
had  become  affected ;  his  muscles  were  flabby  and  tremulous,  like  those  of  a 
spirit-drinker,  and  his  temper  had  become  irritable.  There  was  no  pain  on 
pressing  the  epigastrium.  The  appetite  was  moderate,  and  the  evacuation  of 
the  bowels  was  daily.  After  taking  Iron  for  a  fortnight,  his  nervous  symp- 
toms were  much  amended,  but  he  complained  of  the  flatulence,  and  the  bowels 
were  costive.  He  was  ordered  Quinine  with  Strychnine,  and  pills  of  Aloes 
and  Myrrh',  which  seemed  to  suit  him  well,  for  I  find  no  note  of  any  future 
change  of  medicine. 

It  may  be  presumed  from  the  permanence  of  a  chronic  effect 
arising  out  of  a  temporary  cause,  that  in  such  cases  as  this  some 
structural  change  takes  place  in  the  organ  primarily  affected. 
But  what  that  change  is  nobody  knows.  It  is  not  chronic  in- 
flammation, ulceration,  or  thickening ;  or  else  pain  on  pressure, 
either  sharp  or  dull,  would  be  found.  Perhaps  it  is  a  sort  of 
dilative  paralysis,  such  as  occurs  in  hollow  organs  like  the 
bladder  from  sudden  unwonted  stretching.  But  this  will  be 
spoken  of  hereafter,  when  we  come  to  speak  of  the  structural 
changes  of  the  viscera.  At  present  we  have  to  do  with  it  only 
as  a  cause  of  the  lightest  degree  of  indigestion,  the  amylaceous. 

The  use  of  Aloes  and  Myrrh  (the  Pilula  Aloes"  et  Myrrhse  of 
the  British  Pharmacopoeia)  has  been  spoken  of  as  ordered  in 
this  case.  It  is  not  merely  a  purgative,  nor  would  any  other 
purgative  do  as  well.  On  the  contrary,  most  purgatives  would 
probably  have  been  injurious.  Gamboge,  Senna,  Sulphate  of 


INDIGESTION    OF    VARIOUS    FOODS.  41 

Magnesia,  Colocynth,  Mercury^  and  several  others  which  pro- 
duce elimination  of  serum  and  increase  secretion  generally,  do 
harm  just  in  proportion  to. their  activity.  It  seems  established, 
by  the  experiment  of  making  them  act  when  injected  in  a  fluid 
form  into  the  circulation,  that  their  soluble  principles  have  a 
destructive  agency  upon  the  blood ;  whereas  the  soluble  alkaloid 
in  Aloes  (aloine)  is  a  bitter  tonic,  and  the  purgative  power 
tea  in  its  insoluble  resin.  It  is  very  moderately  eliminative 
— in  small  doses  it  but  adds  to  the  solid  excreta  of  the  colonic 
Is,  and  elicits  matter  feculent  in  smell  and  of  consistent 
f«  >rm — whilst  at  the  same  time  it  strongly  restrains  by  its  bracing 
bitter  the  formation  of  mucus.  See  its  effect  on  moist  piles,  how 
it  dries  them  up  and  often  makes  them  smart!  And  we  may 
judge  from  this  what  its  action  on  the  gastro-intestinal  mucous 
membrane  is.  At  the  same  time,  by  the  more  vigorous  peris- 
taltic movement  and  by  the  solid  mass  passed  along  the  gut,  the 
already  existing  mucus  is  cleared  away.  Aloes  is  thus  employed 
strictly  as  a  clearer  of  the  intestinal  membrane,  and  it  is  joined 
with  Myrrh,  partly  to  divide  it  minutely  and  make  a  small  dose 
go  further,  and  partly  to  give  the  patient  the  benefit  of  the  extra 
resin. 

I  am  particular  in  enlarging  upon  this  point  from  a  fear  lest 
any  words  of  mine  should  be  construed  as  an  encouragement 
to  an  unfortunate  tendency,  common  to  both  the  public  and 
our  profession,  towards  commencing  treatment  habitually  with 
destructive  remedies.  Some  call  this  "clearing  the  decks  for 
action ;"  in  a  majority  of  instances  they  may  be  said  to  throw 
overboard  much  of  the  best  tackling  in  the  ship  and  loosen  her 
armor-plates.  A  so-called  "sluggishness  of  the  liver"  is  a 
ire.|nent  pretext.  In  a  half-nourished  person  (and  all  invalids 
are  ex  vi  termini  but  half-nourished)  the  feces  are  apt  to  be 
light-colored  and  scanty,  inasmuch  as  the  blood  they  come 
from  is  light-OOlored  and  scanty.  Blue  Pill  gives  them  imme- 
diately a  darker  hue  and  increases  their  quantity,  but  sadly  at 
the  cost  of  tin;  patient's  strength,  while  the  temporary  change 
soon  passes  off.  Meat  and  Iron  produce  the  same  result,  by 
LMvitiir  them  more  to  l.e  made  out  of,  and  this  improvement  is  a 
real  and  permanent  one. 


42  INDIGESTION    OF    VARIOUS    FOODS. 

I  have  hitherto  said  nothing  about  the  influence  of  the  mind 
in  inducing  indigestion.  Perhaps  to  that  more  often  than  to 
any  other  cause  the  history  of  it  may  be  traced  in  the  classes 
of  society  placed  above  the  chance  of  physical  want.  I  have 
no  notes  of  ever  having  attended  any  patient  suffering  only 
temporarily  from  this  cause ;  it  is  scarcely  a  case  for  a  doctor ; 
but  probably  every  one's  personal  experience  will  supply  him 
with  an  instance  of  it.  More  commonly  our  professional  ex- 
perience supplies  us  with  examples  like  the  following : — 

CASE  XIV. — My  old  patient  T — ,  an  anxious  lawyer  aged  between  30  and 
40,  with  a  young  family,  complains  that  whenever  he  has  to  see  a  worrying 
client  (and  clients  seem  to  become  more  worrying  than  they  used  to  be),  his 
mouth  gets  dry,  his  hands  and  feet  get  cold,  his  eyeballs  burn,  his  head  gets 
in  a  whirl.  He  goes  home  to  dinner  with  a  pain  in  his  loins,  but  with  a  good 
appetite.  His  food  lies  like  lead  on  his  stomach,  and  seems  to  produce  an 
intense  headache.  Once  in  bed,  he  drops  to  sleep ;  but  he  is  woke  up,  at 
four  in  the  morning  at  the  latest,  by  either  eructations  or  wind  in  the  bowels. 
If  this  can  be  passed  off  he  feels  somewhat  better,  and  can  go  to  sleep  again. 
I  persuaded  him  to  give  up  his  house  in  London  and  sleep  in  the  country, 
which  seemed  for  some  time  almost  to  make  him  a  new  man,  but  he  still  suf- 
fers in  some  degree  from  his  weakness  of  nervous  power,  whenever  he  has 
any  but  the  most  routine  business  to  do. 

I  suppose  such  cases  will  always  be  common,  so  long  as 
society  demands  brain- work,  highly  rewards  it  and  concentrates 
in  such  places  as  this  metropolis.  Eemark  the  sequence  of 
events :  the  mind  occupies  the  whole  business  of  the  brain ; 
no  nervous  energy  is  left  to  preside  over  the  secretions ;  the 
mouth  is  dry  from  lack  of  saliva,  and  if  we  could  see  them  we 
should  probably  find  the  oesophagus  and  stomach  dry  also ;  the 
amylaceous  food  is  not  converted ;  it  lies  like  a  weight  at  the 
epigastrium  till  it  undergoes  a  chemical  instead  of  an  organic 
solution;  it  ferments,  and  gives  out  carbonic  acid.  In  the 
mean  time  the  tired  brain  is  causing  headache,  and  laying  the 
blame  of  its  pains  on  the  stomach  ;  whereas  its  own  weakness 
was  the  cause  of  all  the  troubles. 

It  is  a  foolish  plan  for  a  lawyer  to  sympathize  too  deeply 
with  his  clients — they  do  not  want  his  sympathy,  they  want  his 
help  and  his  reason ;  and  they  will  get  both  of  a  better  quality, 
if  he  does  not  make  himself  ill  by  overcaring. 

Where  the  nervous  system  is  so  irritable,  Strychnine  does 


INDIGESTION    OF    VARIOUS    FOODS.  43 

not  seem  to  avail.  I  gave  it  as  a  tonic  in  this  case,  but  without 
•lit.  Charcoal  brings  temporary  relief,  but  it  is  a  bulky, 
troublesome,  gritty  powder,  and  in  chronic  cases  a  man  cannot 
go  on  for  ever  taking  it.  Occasional  courses  of  Quinine  and 
occasional  courses  of  mild  Alkalies  seem  of  most  use. 

Sometimes  the  determining  agency  to  the  stomach  is  a  sud- 
dou  mental  shock,  such  as  this  :  — 

CASE  XV.  —  Edward  F  —  ,  a  man  of  40,  had  had  dysentery  in  1852,  but  had 
been  fairly  strong  again  till  a  few  months  before  he  came  to  me  early  in  May, 
I860,  when  the  failure  of  a  bank  completely  upset  him.  He  began  to  suffer 
from  a  feeling  of  weight  at  the  epigastrium,  and  of  palpitation  of  the  heart 
after  dinner,  which,  however,  would  be  relieved  by  eructation.  He  had  noc- 
turnal flatulence,  he  lost  his  marital  vigor,  and  grew  thin.  His  nose  too  had 
got  red,  which  a  man  of  40  still  careful  of  his  appearance  does  not  like.  I 
saw  him  again  twice  in  June,  by  which  date  some  powders  of  Strychnia  and 
IVpsine,  which  I  ordered  him,  and  time,  seemed  to  have  been  effectual  in 
setting  his  digestion  right,  and  he  was  able  to  gratify  a  wish  to  travel  on  the 
Continent. 

More  commonly  the  mental  distress  is  of  a  wearing  character 
rather  than  a  sudden  shock. 

1  K  XVI.  —  John  C  —  ,  aged  55  (Dec.  2,  1862),  had  been  slowly  becoming 
bankrupt  for  some  years,  though  in  point  of  fact  he  was  safe  from  physical 
want.  He  was  also  unhappy  at  home  through  the  misconduct  of  a  wife. 
During  this  time  he  first  began  to  suffer  habitually  from  oppression  at  the 
epigastrium  after  meals,  so  as  to  grow  particular  in  his  diet,  and  from  ex- 
perience to  eschew  potatoes.  After  food  he  felt  something  "  working  up  and 
down"  as  if  flatus  was  trying  to  come  up.  He  had  grown  emaciated,  and 
lost  as  much  as  thirty  pounds  in  weight,  and  his  fecal  evacuations  were 
scanty  and  irregular. 

In  the  last  instances  quoted  there  was  no  previous  state  of  the 
internal  viscera  which  could  be  suspected  of  having  determined 
the  weakness  to  the  stomach.  But  that  is  rather  the  excep- 
tion than  the  rule.  Mental  causes  are  much  more  powerful 
Avhen  joiiifi.l  to  some  previous  pathological  condition.  As  in  the 
followin  :  — 


CAM  XVII.—  Mrs.  P.—.  iiL'fd  CO,  came  under  my  care  in  July.  1861.  She 

had   li.i<l   lu-niii-liial   catarrh  with   frothy  sputa   l'«>r   several  winters,   luit  had 
suffered  little  from  h'-r  stomach.      In  tin-  early  part  of  the  year  she  hail 

nursing  a  son-in-law,  a  patient  of  mine,  with  pulmonary  voinica.  ami  had 


44  INDIGESTION    OF    VAEIOUS    FOODS. 

naturally  experienced  much  anxiety  on  his  account.  This  was  followed  by 
pain  in  the  right  hypochondrium  and  a  sensation  of  cramp  in  the  stomach 
when  it  was  empty.  Vegetable  food  produced  flatulence  and  was  avoided. 
Apparently  in  consequence  of  that  the  bowels  had  become  costive.  She  also 
occasionally  suffered  from  water-brash. 

Is  it  not  fair  to  assume  that  the  catarrhal  condition  which  had 
affected  the  pulmonary  travelled  to  the  gastric  mucous  mem- 
brane? that  the  patient,  in  fact,  had  a  catarrhal  diathesis  which 
by  the  slowness  of  digestion  resulting  from  the  mental  worry 
was  fixed  in  the  stomach?  So  that  the  dyspepsia  remained 
though  the  external  cause  of  anxiety  was  removed. 

The  chief  mode  in  which  chronic  catarrh  induces  dyspepsia 
I  believe  to  be  by  enveloping  the  food  and  impeding  the  gastric 
juice  from  freely  mixing  with  it  in  the  stomach;  thus  the 
starch  which  had  escaped  the  mixture  with  saliva  by  being 
unbroken  remains  still  undissolved.  The  mucus  further  on  in 
the  ilia  and  in  the  colon  by  its  slipperiness  and  elasticity  pre- 
vents the  muscles  of  the  gut  from  duly  urging  forwards  the 
mass.  Hence  we  have  the  starch  fermenting  and  generating 
gases  and  morbid  acids,  relieving  pain,  indeed,  for  a  certain 
period  after  it  is  swallowed,  but  by  the  above-mentioned 
chemical  decay  producing  infinite  distress  in  the  later  periods 
of  digestion,  failing  to  afford  nutriment  in  the  intestines,  and 
causing  costiveness  when  it  gets  lower  down,  making  the  feces 
lumpy,  slimy,  and  hard. 

I  shall  in  a  future  chapter  recur  to  this  connection  between 
the  mucous  membrane  of  the  lungs  and  of  the  stomach,  when  I 
review  the  subject  of  what  is  called  phthisical  dyspepsia,  where 
a  permanent  pathological  condition  of  the  respiratory  viscera 
produces,  or  seems  to  produce,  a  very  obstinate  form  of  derange- 
ment of  the  digestive  viscera,  as  a  secondary  consequence. 

At  the  latter  end  of  the  cholera  epidemic  of  1854,  when  the 
plague  was  becoming  more  general  but  less  fatal,  I  used  to  see 
a  good  many  such  cases  as  the  following : — 

CASE  XVIII. — Joseph  W — ,  aged  42,  a  laborer,  had  an  attack  of  the 
prevailing  diarrhoea  in  August.  From  that  time  till  he  came  to  St.  Mary's 
on  October  27,  though  his  appetite  was  good,  his  bowels  had  never  recovered 
their  healthy  action,  being  always  either  costive  or  relaxed.  Lumps  of  un- 
digested vegetable  food  used  to  appear  in  the  feces.  For  the  last  three  weeks 


INDIGESTION    OF    VARIOUS    FOODS.  45 

al-n  lie  had  suffered  from  pyrosis.  The  tongue  was  large,  flabby,  and  redder 
than  natural,  as  if  skinned.  The  epigastrium  was  tumid  and  drummy.  The 
kidneys  seemed  quite  to  have  recovered  the  choleraic  congestion,  for  the  urine 
was  acid,  clear,  and  free  from  albumen,  though  (as  in  most  dyspeptics)  of 
low  specific  gravity,  l.nlt;.  lie  was  treated  with  rest  in  bed.  liquid  animal 
f.M.d.  I'.ismntli.  warm  baths,  and  < 'astor  Oil.  And  the  treatment  seems  to 
uitcd,  for  he  was  discharged  "cured"  (which means  in  hospital  language 
'•  well  enough  to  go  to  work")  on  November  1.  But  I  presume  some  symp- 
toms remained,  for  he  was  ordered  to  take  a  store  of  Bismuth  with  him. 

This  is  an  instance  of  the  partial  paralysis  of  the  vital  powers 
of  the  digestive  organs  which  often  succeeded  to  choleraic  diar- 
rhn-a — I  think  more  often  in  moderately  mild  cases  than  in  the 
most  severe.  I  suppose  because  they  got  about  too  soon;  just 
as  dropsy  oftener  occurs  after  slighter  scarlet  fevers  than  after 
dangerous  attacks. 

It  is  wrong  to  class  .such  cases  as  inflammation  of  the  stomach 
ami  bowels,  for  there  are  none  of  the  usual  accompaniments  of 
inflammation,  such  as  heat  of  skin,  quick  pulse,  thirst,  or  even 
loss  of  appetite.  So  that  unless  the  word  inflammation  is  to  be 
m;ulo  coextensive  with  disease,  it  cannot  include  them. 

A  return  to  the  district  infected  by  the  cholera  poison  will 
be  apt  to  cause  a  relapse  in  those  who  have  got  rid  of  their 
tliurrhci.-a  by  temporary  removal,  as  happened  in  the  following 
incident  of  the  visitation,  which  now  in  trembling  hope  we  call 
"  the  late  epidemic." 

CASK  XIX. — Mr.  V — ,  aged  35,  a  chemist  and  druggist  at  the  east  end  of 
London,  came  to  me  on  the  13th  of  October,  1866.  During  the  prevalence 
of  the  epidemic  in  the  early  summer  months  he  had  experienced  an  alt  ark  of 
choleraic  diarrhu-a,  with  cramps.  Arc.  On  his  recovery  he  was  too  weak  in 
attend  to  business,  so  he  left  London  for  a  six  weeks'  holiday,  and  then  felt 
quite  well.  On  returning  to  his  work,  he  was  careful  not  to  over-exert  him- 
self; but  still  he  had  no  sooner  be^un  to  sleep  in  the  house  than  his  rest  was 
disturbed  by  flatulence  and  diarrlm-a;  this  morbid  looseness  of  bowels  often 
alternating  with  costiveness.  giddiness,  and  confusion  of  ideas.  The  feces, 
instead  of  being  formed,  homogeneous,  and  of  natural  odor,  as  in  the  country, 
cuiitaineil  large  lumps  of  unaltered  food,  and  smelt  like  rotten  hV>h.  A  second 
absence  from  home  relieved  in  a  few  days  the-e  symptoms,  and  again  a  return 
brought  them  back.  A  third  holiday  was  air.iin  effectual,  and  now  in  October 
he  was  very  anxious  to  ir«'t  hack  to  work  :  but  still  he  has  a  slight  threatening 
of  the  indigestion  of  food  in  the  <t.nna--h.  indicated  by  loss  of  appetite  and 
flatulence.  My  prescription  was,  a  careful  abstinence  from  puriMtivcs,  and 


46  INDIGESTION    OF    VARIOUS    FOODS. 

a  draught  containing  two  grains  of  Quinine  and  s'5th  of  Strychnia  twice  a  day, 
which  appears  to  have  been  at  last  effectual. 

It  would  seem  that  the  external  cause  of  cholera,  whatever 
its  nature  or  seat  may  be,  remains  behind  still  active,  after  all 
those  most  prominently  sensitive  to  it  have  been  affected,  and 
that  it  is  still  poisonous,  though  in  a  minor  degree.  The  im- 
pression I  receive  from  the  facts  we  possess  is,  that  there  is 
actually  a  poisonous  material  very  generally  diffused  during 
epidemics,  and  occasionally  generated  also  sporadically  at  other 
times ;  and  that  most  of  us  very  frequently  digest  it,  assimilate 
it,  or  otherwise  destroy  it,  as  we  may  do  other  poisons  or  drugs, 
without  injury  or  with  very  slight  injury.  Like  the  eggs  of 
tapeworms,  only  a  small  fraction  of  what  is  generated,  finds  a 
suitable  home. 

But  that  is  no  argument  in  favor  of  the  evacuant  treatment. 
We  have  no  evidence  that  the  poison,  conjectured  to  exist,  and 
to  be  of  a  purgative  nature,  remains  in  the  body  Curing  the 
continuance  of  its  effects.  No  one  takes  for  granted  that  a 
bullet  which  has  injured  a  rib  is  still  to  be  extracted — he  turns 
his  attention  to  curing  the  wound.  To  treat  cholera  by  purga- 
tives seems  to  me  very  like  hoping  to  counteract  an  overdose  of 
Elaterium  by  an  overdose  of  Colocynth.  Probably  the  minor 
purgative  does  not  increase  the  risk  in  severe  cases,  for  it  is 
carried  off  safely  by  the  major  purgative,  but  I  do  not  see  how 
its  use  can  be  justified  by  rational  physiology. 

It  was  on  these  grounds  that  I  advise  an  abstinence  from 
purgatives  in  such  cases  as  last  related. 

I  believe  that  the  indigestion  following  choleraic  diarrhoea  is 
very  much  kept  up  by  the  habitual  taking  of  purgatives. 

CASE  XX. — T.  E.  D — ,  a  surgeon,  aged  69,  who  had  passed  many  years  in 
India,  consulted  me  about  himself.  February  4th,  1867.  Though  exposed  to 
epidemic  and  other  noxious  influences  of  tropical  climates,  he  had  never  i 
suffered  from  them;  and  this  exemption  he  attributed  to  a  congenital  slowness 
of  digestion  having  kept  him  from  the  self-indulgent  habits  of  excess  which  a 
few  years  ago  were  so  common  among  our  countrymen  abroad.  Last  year, 
however,  being  at  Edinburgh  during  the  invasion  of  cholera,  he  was  attacked 
with  diarrhoea,  which  was  succeeded  first  by  constipation,  and  that  by  a  return 
of  diarrhoea,  which  then  assumed  a  chronic  form.  Then  he  caught  a  severe 
cold  on  the  chest,  on  which  the  abdominal  affection  ceased.  But  on  the  cough  * 
being  relieved,  the  looseness  of  bowels  returned. 


INDIGESTION    OF    VARIOUS    FOODS.  47 

H>  described  himself  as  being  woke  up  at  four  in  the  morning  by  a  feeling 
of  discomfort  about  and  above  the  navel,  then  there  was  as  it  were  a  working 
or  fermentation  in  the  belly  generally,  and  sometimes  a  burst  of  wind  upwards 
by  eructation,  but  more  commonly  a  resonant  gurgling,  and  then  followed  a 
feeling  of  relief  without  any  explosion  per  anum  necessarily  taking  place. 
After  breakfast  there  was  again  discomfort  and  flatulence.  The  stools  were 
cithor  watery  or  pultaceous,  with  occasional  lumps  of  ragged  matter.  The 
urine  was  variable,  often  pale  and  watery,  often  thick  and  highly  colored. 
Tin-  pulse  had  the  emptiness  and  sharpness  indicating  the  inelastic  arteries 
of  old  age.  and  was  quicker  than  natural.  The  palms  were  hot  and  dry.  The 
te  was  white  and  furry.  The  appetite  was  good,  and  the  usual  diet  of 
the  easy  classes  was  taken  with  satisfaction  and  without  any  consequent  epi- 
gastric distress. 

I  found  that  he  had  a  "dinner-pill"  of  his  own,  consisting  of  Colocynth, 
Ipecacuanha,  and  Henbane,  which  he  took  before  dinner,  and  then  he  said 
there  was  after  an  action  of  the  bowels  before  going  to  bed,  and  the  morning 
di-'-uinfort  was  alleviated  if  not  prevented.  Still  it  returned  again,  and  he 
thought  it  got  worse.  He  therefore  had  somewhat  lost  faith  in  his  favorite 
pill,  and  having  to  his  surprise  experienced  much  solace  from  a  few  drops  of 
Chlorodyne  taken  at  night,  came  to  consult  me  about  it. 

I  advised  him  entirely  to  give  up  the  purgative  pill,  to  take  the  Chlorodyne 
for  a  short  period,  then  to  try  and  do  without  it,  and  to  have  a  bouillon  and  a 
glass  of  wine  for  breakfast,  instead  of  the  ordinary  British  fare. 

Doubtless  the  production  of  indigestion  after  acute  illnesses 
is  most  frequent  where  those  illnesses  have  specifically  affected 
the  alimentary  canal.  Yet  we  find  it  follow  also  other  serious 
(lisv;i>.->,  though  quite  unconnected  with  that  mucous  membrane. 

Thus— 

\  XI. — Harriet  R — ,  a  pale  single  woman,  aged  42,  was  ill  enough  to 
be  admitted  an  in-patient  at  Saint  Mary's,  July  12. 1862,  a  time  of  year  when 
slight  cases  are  usually  kept  out.  She  complained  of  pain  at  the  epigastrium 
•  •re  that  she.  tnok  hardly  any  solid  food,  living  mostly  on  tea.  The  mouth 
was  dry  and  sticky,  her  appetite  was  gone,  the  urine  was  of  the  specific  gravity 
of  only  1.010  and  scarcely  acid,  the  pulse  108,  quick  and  small,  the  catamenia 
hu<l  become  irregular  and  alnmst  ceased.  This  state  of  innutrition  she  attri- 
buted to  a  rheumatic  fever  a  year  liefore,  since  which  time  she  had  experienced 
this  pain  at  the  epigastrium  enticed  by  the  amylaceous  food  which  only  she 
could  <ret.  She.  however.  -veil  milk  and  lime-water,  and  in  a  week 

was  eating  "  ordinary  diet." 

Still  further  removed  from  the  stomach  is  the  following 
origin: — 

>i  XII. — The  immediate  cause  of  M.  A.  S —  coming  under  my  care  on 
January  23,  1855,  was  an  attack  of  cramp-like  pain  after  a  meal  at  which  she 


48  INDIGESTION    OF    VARIOUS    FOODS. 

had  eaten  both  rice  and  potatoes.  But  I  found  that  she  had  suffered  after 
vegetable  food  for  many  months,  and  that  this  weakness  was  traced  by  her 
to  her  last  child-labor,  up  to  which  time  she  had  always  been  strong.  Her 
stomach  was  so  blown  out  by  the  immediate  illness,  and  so  painful  for  several 
days,  that  I  had  to  put  on  some  leeches  and  feed  her  on  milk  and  lime-water, 
but  I  doubt  not  that  a  lesser  degree  of  the  same  condition  was  habitual  to  her. 
She  seemed  to  have  been  flatulent,  and  had  costive  bowels  ever  since  the  birth 
of  her  last  child. 

Those  in  whom  dyspepsia  is  produced  by  a  mucous  diathesis 
of  the  internal  membranes  are  peculiarly  affected  by  climatic 
influences.  The  union  of  cold  and  damp  found  in  an  ordinary 
English  winter  is  the  most  common  exciting  cause,  making 
familiar  such  cases  as  this. 

CASE  XXIII. — Henry  L — ,  a  schoolmaster,  first  made  himself  ill  at  the  age 
of  28  by  reading  too  hard  for  an  University  degree.  His  nervous  system  was 
completely  prostrated.  This  was  at  the  end  of  the  summer  of  1860.  In  the 
succeeding  winter  he  began  to  feel  a  weight  at  the  epigastrium  after  eating, 
and  a  strange  kind  of  vertigo,  as  if  the  ground  were  falling  away  from  under 
his  legs.  He  would  have  sudden  flushes  and  perspirations.  If  he  could 
eructate  any  considerable  amount  of  flatus  there  was  an  immediate  relief  to 
the  symptoms.  His  nights  were  disturbed  by  cramps  and  by  wind  rolling 
about  in  his  bowels,  as  if  tbey  were  going  to  act.  But  no,  they  were  consti- 
pated. He  found  acid  often  rising  in  the  throat,  and  occasionally  vomited  a 
mass  of  stringy  mucus.  During  the  summer  he  was  much  better,  and  he  was 
able  to  play  at  cricket,  but  when  I  first  saw  him,  in  December,  1861,  his  old 
miseries  were  returning  with  double  force.  He  was  getting  very  weak  and 
nervous,  his  tongue  was  white  and  tremulous,  his  pulse  very  rapid,  and  he 
said  that  occasionally  he  was  quite  hysterical.  Iron  did  not  seem  to  suit  him, 
in  spite  of  the  evident  anaemia.  But  Quinine  regularly,  and  pro-re-natd  doses 
of  Valerian  were  of  use.  He  has  diligently  gone  on  with  occasional  courses 
of  this  treatment,  and  suffers  very  much  less.  He  is  quite  well  every  summer, 
but  at  the  beginning  of  each  Christmas  holidays  he  is  threatened  with  a  re- 
lapse and  comes  to  be  encouraged  to  ward  it  off. 

In  the  last  case  the  failure  of  the  nervous  system  was  a  cause 
of  the  failure  of  the  digestive  powers,  but  the  circle  of  events 
sometimes  turns  the  other  way  round  in  this  class  of  cases  which 
are  affected,  as  now  described,  by  climatic  influences. 

CASE  XXIV. — Mrs.  R — ,  aged  34,  the  mother  of  four  children,  is  the  wife 
of  a  thriving  tradesman,  and  certainly  as  little  exposed  to  any  strain  on  the 
mental  powers  as  any  one  I  know.  But  she  is  fat,  leuco-phlegmatic,  subject 
to  leucorrhoea  and  to  mucous  discharge  with  prolapsus  of  the  rectum.  She 
is  costive,  and  was  much  in  the  habit,  till  I  told  her  not,  of  taking  purgatives. 


INDIGESTION"    OF    VARIOUS    FOODS.  51 

to  take  toll  from  each  passing  delicacy  at  the  tai>]e-d'hote.  But 
vou  will  soon  see  them  returning  to  tea  and  toast  at  the  one, 
and  restricting  their  performances  at  the  other  more  and  more 
to  t:  ;>!es  ami  the  maccaroni. 

unot  s;r  •••  with  those  who  attribute  to  this  vege- 

tal .lc  diet  the  comparative  freedom  from  indigestion;  such  an 
MS  to  me  a  confusion  of  cause  and  effect.  For  we 
all  more  or  less,  I  suppose,  admit  the  value  of  meat  diet  in 
curing  such  complaints.  The  freedom  seems  to  me  the  rather 
due  to  that  vigorous  condition  of  the  mucous  membranes  which 
the  climate  insnr 

.ipare,  for  example,  the  amount  and  the  intensity  of  such 
a  di><  '  "nronic  Bronchitis  in  Italy  and  in  England.     At 

St.  Mary's  Hospital,  London,  in  the  patients  admitted  between 
1853  and  isill  inclusive,  1  in  every  32  was  a  case  taken  in  for  • 
Chronic  Bronchitis.     In  the  statistics  of  Milan  Hospital  which 
I  have  compared  with  them  in  a  little  volume  published  last 
.  there  is  oniy   1  in  SS23.1 

dry  ness  of  the  air  without  excessive  heat  or  cold  renders 
it  needless  for  the  mucous  membranes  to  put  on  their  slimy 
winter  coats.  They  are  in  a  more  active  condition  for  the  work 
of  absorbing  oxygen,  digesting,  extracting  nutriment  or  water, 
or  whatever  else  they  are  required  to  do.  They  are  filled  with 

:,  and  pass   it   on  rapidly  with  its  fresh  burden  of  ren< 
life  to  the  rest  of  the  body.- 

1  "Some  Effects  of  the  Climate  of  Italy,"  p.  41. 

2  Tin-  teim  1'V  which  anatomists  have  designated  this  tissue  is  apt  to  lead 
even  tin-  most  thoughtful  of  us  into  a  fallacy.     . \.-iv.-  members  of 

named  after  the  work  which  is  their  most  important  occupation.     Tim  industry 
of  the  lawyer  is  the  administration  of  the  law  ;  the  doctor  iu  any  faculty  ought 
at  any  rate  to  lie  learned  enough  to  teach;  the  duty  of  bishops  and  overseers  is 
iirtffxtirH* — to  ovri>fe — each  their  several    depai  fluent-.       Hut    the    cl 
mucou-  m-iiil.]  mucus.      It   is  most   active  wh- 

doinc  so.  and  it-  activity  i  just   in  proportion   to  the  copiousness  of 

the  mucus.  Typical  health  certainly  consists  in  its  ahsi-nce  ;  robust  people 
pass  weeks  without  expectorating;  many  lind  their  handkerchiefs  clean  and 
unfolded  att'-r  si-veral  days  in  their  pockets,  spite  of  all  the  voluntary  and  in- 
voluntary irritants  to  which  the  Sclnieideriaii  memhraiie  is  subject;  and  the 
urinary  and  intestinal  outlets  ordinarily  contribute  only  an  intinite-imal  quan- 
tity, wliich  may  fairly  be  attributed  to  a  temporary  defect  in  some  fraction  of 
their  large  area. 

The  real  office  of  mucous  membrane  is  to  offer  a  passage  inwards  for  oxygen, 


52  IXDIGESTIOX    OF    VAEIOUS    FOODS. 

The  indigestion  of  starch  is  in  point  of  fact  the  indigestion  of 
sugar,  for  it  is  into  the  latter  substance  that  it  is  converted  by 
either  the  action  of  the  saliva  immediately,  or,  in  lack  of  that, 
"by  the  contact  with  the  mucous  membranes  slowly.  It  is  there- 
fore quite  natural  to  find  that  any  excess  of  sugar  taken  ready- 
made  induces  discomfort  in  dyspeptic  patients.  It  is  undigested, 
and  the  greater  part  of  it  undergoes  acetic  fermentation  by  the 
second  or  third  hour  after  it  is  eaten.  Some  perhaps  may 
undergo  alcoholic  fermentation,  and  generate  the  excess  of 
carbonic  acid,  which  fills  the  alimentary  canal  with  flatus. 

During  its  fermentation  it  also  encourages  fermentation  in 
other  articles  of  food,  and  by  its  presence  oleaginous  food  is  apt 
to  be  rendered  indigestible  also.  Great  discomfort  will  some- 
times go  on  for  a  long  time  from  this  cause  without  being  sus- 
pected, and  cease  by  the  simple  expedient  of  leaving  off  so  little 
necessary  a  constituent  of  diet  as  sugar. 

CASE  XXXI. — Edward  W — ,  a  gentleman  farmer,  aged  45,  and  inclined  to 
corpulence,  came  to  me  in  March,  1848,  complaining  of  extreme  pain  running 
up  the  back  of  the  sternum  in  the  third  hour  after  almost  every  meal,  but 
especially  after  breakfast.  This  was  followed  by  intense  headache  and  giddi- 
ness, so  that  he  feared  he  was  going  to  have  apoplexy.  On  examination  of 
the  stomach  it  was  not  painful  on  pressure,  but  drummy  to  percussion  close 
up  to  the  cardiac  pulsation. 

I  gave  him  a  course  of  Colocynth  and  Mercurial  purgatives,  and  saw  him 
again  in  July.  The  headache  and  the  fear  of  apoplexy  was  then  relieved, 
but  the  dyspeptic  pain  was  as  bad  as  ever,  and  the  tongue  was  very  yellow 
and  thickly  coated.  I  desired  him  to  abstain  from  sugar  and  to  take  his 
morning  tea  with  a  slice  of  lemon  in  it. 

In  March,  1850,  he  came  to  me  for  a  gonorrhoea  which  had  become  obsti- 
nate, and  I  asked  him  about  his  dyspeptic  symptoms.  He  said  abstinence 
from  sugar  had  quite  cured  them. 

In  addition  to  these  pains  caused  by  its  fermentation,  sugar 
will  in  some  instances  cause  pain  immediately  on  its  ingestion. 
It  has  seemed  to  me  most  probable  that  in  such  cases  there  is 
some  rawness  or  local  morbid  sensitiveness  of  surface  in  the 
primae  via3,  and  that  the  pain  is  analogous  to  the  peculiar  sort 
of  twinge  which  the  presence  of  sugar  will  cause  in  a  tooth 

water,  fat,  albumen,  and  other  useful  substances,  and  to  defend  the  less  easily 
renewed  ^.issues  beneath  it  from  the  deleterious  action  of  external  agents.  These 
functions  it  best  fulfils  when  it  is  bedewed  with  a  moderate  exhalation,  and  not 
with  mucus. 


INDIGESTION    OF    VARIOUS    FOODS.  53 

unnaturally  sensitive  from  caries,  or  even  from  neuralgia  with- 
out solution  of  continuity.  This  pain  arises  too  immediately  to 
be  due  to  decomposition.  Syrup  does  not  cause  it,  but  only 

lull'' : 

SECTION  II. 

Uyestion  of  Albumen  and  Fibrin. 

Grazing  animals  are  obliged  to  take  their  food  leisurely,  so 
mix  it  up  with  the  secretions  of  the  mouth,  and  many  of 
them  even  to  bring  it  up  and  chew  it  again,  if  they  would 
not  have  it  ferment  in  the  bowels  and  risk  a  rupture.  On 
the  other  hand,  to  beasts  of  prey  the  only  use  of  saliva  seems 
to  be  the  keeping  their  throats  moist.  They  need  to  chew  the 
morsel  only  enough  to  prevent  it  sticking  in  the  oesophagus. 
It  would  appear  that  while  vegetables  require  for  their  perfect 
digestion  a  perfect  condition  of  the  whole  alimentary  canal  as 
sketched  out  in  the  previous  section,  flesh-meat  is  at  least  inde- 
pendent of  the  salivary  glands. 

And  this  observation,  drawn  from  natural  history,  is  quite 
confirmed  by  physiological  experiment,  which  finds  the  peculiar 
solvent  of  albumen  and  fibrin  in  the  gastric  glands.  These 
<rlands  the  salivary  can  only  aid  by  affording  an  aqueous 
diluent. 

There  is  also  this  difference  between  the  digestion  of  starch 
and  of  albumen,  that  whereas  normally  the  former  should  be 
rapidly  converted  into  an  absorbable  substance,  and  rapidly 
•  in  the  upper  part  of  the  alimentary  canal;  the  latter 
not  begin  to  be  dissolved  till  the  food  has  proceeded  a 
considerable  distance,   and  the  action  is  continued  for  nearly 
the  whole  of  its  course.    In  the  healthy  subject,  a  great  portion 
of  ti  taken  up  before  the  albumen   is  all' 

at  all. 

we  miv;ht  have  expected,  the  digestion  of  animal  food  is 
interfered   with    by  external   circumstances,  ami  therefore 

lently   interfered   with  than  that  of  vegetal)!- 
derable  debilitating   action   on   the   nervous   sv>tem    . 
quired  to  produce  even  an  acute  temporary  dvspepsia  of  : 


5-i  INDIGESTION    OF    VAEIOUS    FOODS. 

And  I  may  observe  that  it  is  through  the  nervous  system  in 
almost  all  instances  that  proteinous  indigestion  ari.se*. 

We  will  begin  with  the  least  rare  shape  in  which  we  see  the 
disease.  • 

CASK  XXXII.— Lucy  P — ,  aged  22,  a  servant  of  all  work,  debilitated  pre- 
viously by  a  long  rheumatic  fever  and  a  hard  place,  was  admitted  to  St.  Mary'? 
for  scarlatina  anginosa  on  February  22,  1861.  The  throat  was  much  inflamed 
and  a  little  ulcerated.  On  the  2d  of  March  she  was  ordered  ordinary  meat 
diet,  but  the  ingestion  of  it  brought  on  such  severe  pain  in  the  epigastrium 
that  it  was  obliged  to  be  left  off. 

An  example  of  making  the  mistake  of  overhaste  in  the  desire 
to  renew  the  flesh  lost  after  acute  fevers.  A  good  example, 
because  in  anginous  scarlatina,  if  in  any  acute  fevers,  you  would 
expect  the  salivary  glands  to  have  more  particularly  suffered. 
You  would  expect  the  indigestion  of  starch  to  have  been  the 
marked  feature.  But  it  was  not  so,  and  the  deficiency  of  life 
manifested  was  a  following  of  the  genus  fever,  not  of  the  species 
anginous — the  injury  to  the  whole  patient  took  the  precedence 
of  the  injury  to  the  part. 

On  that  ground  I  preserved  a  record  of  the  case,  for  often  as 
it  must  have  happened  in  other  instances  that  my  patients  have 
been  allowed  solid  meat  too  soon,  I  cannot  find  another  note  of 
the  fact.  And  I  must  trust  my  memory  and  my  reader's  expe- 
rience to  assert  that  the  evil  consequences  are  not  confined  to 
scarlatina. 

When  I  say  "  evil  consequences,"  I  do  not  mean  merely  the 
temporary  pain,  but  an  attack  of  feverish  indigestion,  sometimes 
of  vomiting,  which  throws  the  patient  back  some  days. 

It  is  to  be  remarked  that  it  is  not  so  much  the  chemical  com- 
position as  the  form  of  the  aliment  which  renders  it  improper 
for  incipient  convalescents.  Through  the  whole  course  of  a 
typh-fever  a  continuous  supply  of  liquid  flesh  in  the  shape  of 
beef-tea  has  been  kept  up.  If  the  stomach  could  not  digest  it 
the  intestines  did,  and  so  the  patient's  strength  was  sustained. 
But  give  him  a  meal  of  roast  beef,  and  it  rolls  about  in  the 
stomach  till  it  decays ;  digestion  is  impossible,  and  it  causes 
diarrhoea. 

This  caution  is  most  requisite  in  cases  where  a  relapse  is 


INDIGESTION    OF    VARIOUS    FOODS.  55 

Me.  As  for  example  in  fever,  of  either  typhus  or  typhoid 
type,  where  the  bowvls  have  become  inflame«l.  Here  solid 
inav  bring  back  the  worst  features  of  the  <li- 

But  especially  in  rheumatic  fever  there  is  a  painful  necessity 
for  restricting  the  supply  of  nutriment.  If  meat  be  given  before 
the  power  of  fully  converting  it  into  living  flesh  is  restored,  a 
semi-conversion  into  lactic  acid  t;ikes  place.  And  then  a  febrile 
disturbance  is  produced,  which  is  followed  by  a  return  of  the 
rheumatic  pains.  Or  perhaps  rheumatic  fever  really  is  due  to 
an  excess  of  lactic  acid  in  the  blood;  and  if  so  the  relapse  which 
ensues  on  the  generation  of  it  is  readily  explicable. 

Kven  when  the  pains  are  gone  and  there  is  an  urgent  call  for 
replacing  lost  flesh,  the  most  suitable  diet  for  supplying  it  will 
times  bring  on  their  return.  The  redder  and  more  mus- 
cular it  is,  the  more  it  disagrees,  and  we  must  very  cautiously 
get  back  to  "  ordinary  diet,"  else  a  risk  is  run  of  losing  more 
by  a  second  attack  of  the  disease  than  is  to  be  gained  by  haste. 
Vegetable  matter  does  not  expose  patients  to  the  same  danger, 
and  thus  by  dint  of  rice  pudding,  porridge,  gruel,  bread,  mashed 
potatoes,  and  the  like,  you  may  try  to  satisfy  the  mouths  which 
often  loudly  complain  of  starvation.  If  we  cannot  by  such 
arguments  succeed  in  staying  the  appetite,  it  is  our  duty  to  be 
rrurl,  or  experience  will  soon  convince  us  of  the  hurtful  effects 
->lid  meat  in  causing  relapses  of  rheumatic  fever. 

In  acute  diseases  the  condition  of  the  stomach  which  pre- 
vents it  from  digesting  meat  is  merely  temporary,  and  all  that 
is  requisite  is  patience.  But  where  the  failure  of  the  organ  is 
chronic  the  affair  is  much  more  serious.  A  state  of  anaemia  is 
induced  which  is  a  long  time  in  being  recovered  from. 

\  X  XIII.— Kmma  Ch— ,  a «:<•<!  IT.  was  admitted  into  St.  Mary's.  Po- 
com')or  'Jl.  l^.Vi.  in  such  an  extreme  state  <>f  weakness  that  she  was  obliged 
tn  In-  kept  in  l>ed.  'I'll','  pulse  was  11 '2.  there  was  a  systolic  limit  with  the 
•"iind  of  the  heart  ;  the  Im-atli'mir  was  very  short  on  slight  exertion,  the 
caiami-iiia  had  ceased,  and  the  complexion  had  lu-.-om.-  .-leap  and  pale  like 
wax.  She  i  niiiplained  of  extreme  latitude  and  headache.  The  howels  we'-e 
irregular,  reported  costive  on  admission.  l>ut  affected  l>y  diarrlnra  during  the 
second  day  of  admission  after  taking  Woth  with  meat  in  it.  It  appeared  that 
she  alway-  avoided  meat,  that  -he  was  disgusted  with  the  si^ht  of  it.  and  that 
it  caused  pain  in  the  epi-a-trinm.  There  was  also  a  painful  spot  on  the  dor- 


56  INDIGESTION    OF    VARIOUS    FOODS. 

sum  of  the  tongue,  impeding  deglutition  of  solid  meat,  and  this,  spot  and 
others  near  it  were  denuded  of  epithelium  so  as  to  give  a  marbled  aspect  to 
the  part.  For  this  reason  she  had  lived  on  vegetables,  gruel,  bread,  and  tea. 
A  gradual  return  to  a  meat  diet,  through  beef-tea,  eggs  beaten  up  in  wine, 
and  cocoa  at  short  intervals,  aided  by  absolute  rest,  Borax,  Iron,  and  Chalk, 
restored  her  so  by  January  10th  that  she  was  able  to  get  up  and  dress.  Her 
pulse  was  80,  and  firmer,  the  systolic  bruit  was  not  nearly  so  loud  as  at  n'rst, 
and  she  had  some  color  in  her  cheeks.  On  the  12th  she  was  able  to  eat  the 
mixed  "  ordinary  diet"  of  the  hospital.  On  the  15th  she  wanted  to  discharge 
herself  from  my  care ;  but  when  she  lay  down.  I  found  the  systolic  bruit  was 
still  audible;  so  I  kept  her  in  for  a  little  longer  rest,  on  the  excuse  of  having 
her  vaccinated.  She  left  hospital  early  in  February. 

It  is  impossible  for  a  growing  girl  to  make  red  blood  without 
meat,  and  the  longer  she  goes  without,  the  less  able  is  she  to 
digest  it ;  the  power  of  the  gastric  juice  is  lowered  by  the  absti- 
nence. 

As  to  the  organic  cause  of  the  complaint  in  this  instance,  I 
presume  one  may  be  allowed  to  judge  of  the  unseen  by  the  seen, 
and  to  conjecture  that  the  state  submitted  to  our  sight  in  the 
most  conveniently  visible  portion  of  the  alimentary  tissue  (the 
tongue)  was  also  present  lower  down.  And  we  may  rationally 
suppose  it  to  have  been  worse  lower  down,  for  the  special  gastric 
functions  were  defective,  while  the  special  oral  functions  re- 
mained unaffected.  This  superficial  aphthous  state,  where  the 
epithelium  is  destroyed  instead  of  being  raised  into  blisters,  is 
common  in  the  throat,  tonsils,  and  os  uteri,  and  may  by  stimu- 
lating applications  have  the  edges  so  raised  and  the  centre  so 
depressed  as  to  look  exactly  like  ulceration.  Borax  and  Quinine 
soon  cure  it,  and  are  therefore  probably  equally  good  for  the 
stomach  under  the  same  circumstances. 

In  some. cases  of  pulmonary  consumption  we  find  the  stomach 
affected  with  indigestion  of  albuminous  food.  It  is  so  easy  to 
trace  out  a  physiological  chain  of  causation  from  diminished . 
diet,  to  atrophy,  deposit  of  tubercle  and  phthisis,  that  it  is  com- 
monly too  readily  assumed  that  such  is  the  invariable  course  of 
events.  I  do  not  think  so.  It  seems  to  me  extremely  probable 
that  the  condition  of  mucous  membrane  induced  in  the  lung  by 
the  presence  of  tubercle,  may  be  communicated  to  the  stomach-, 
and  that  the  latter  may  be  in  fact  an  effect,  not  a  cause.  Though 
still  it  is  a  most  serious  effect,  which  reacts  upon  and  aggravates 


IN'DIGKSTION"    OF    VARIOUS    FOODS.  57 

tlif  pulmonary  injury.     This  is  a  practical  point,  for  if  it  is  an 
may  lia\v  more  hopes  of  curing  it,  and  so  arresting 
•_ul  loping  consumption  winch  is  so  imminent. 

XXXI  V.—  (Jeorge  C — ,  aged  24.  came  under  my  care  at  St.  Mary's, 

r  I'.'.  1  -."..").    llr  wa*  miii  h  emaciated,  and  had  occasionally  expectorated 
b! ly  streaks  in  the  mucus  from  liis  bronchi.    He  had  also  slight  hectic,  and 

-e  iit'ctnrnal  perspirations.  On  examination  bronchial  breathing  with 
sibilant  rales  was  found  in  the  upper  part  of  the  thorax  on  the  right  side,  and 
that  part  also  w.is  Hatter  than  the  cm-responding  part  on  the  other  side. 
Ihiring  the  last  two  or  three  months  he  had  experienced  pain  during  diges- 
tion. He  had  pain  in  the  epiuast rium  and  occasional  diarrhoea  alternating 
with  constipation.  After  eating  there  was  a  feeling  of  weight  at  the  pit  of 

•••mai-h.     This  was  especially  noticed  after  animal  food.    Milk  even 

d  it  if  taken  without  bread. 

He  got  a  good  deal  better  on  rest.  Quinine,  and  Iron,  and  was  able  to  take 
a  mutton-chop.  Hut  what  seemed  to  do  him  most  good  was  Cod-liver  oil, 
by  the  use  of  which  he  improved  in  spirits,  in  power  of  taking  meat,  and  in 
weight.  He  increased  as  much  as  ten  pounds  avoirdupois  between  October 
•J'.Hh  and  November  Tth,  and  was  discharged  as  well  on  the  9th. 

The  deficient  digestion  of  animal  food  in  phthisis  is  a.  very 
serious  thing.  It  keeps  the  patient  in  such  a  weak  state  that 
1'ata!  i-lVi-cts  follow  shocks  which  could  otherwise  be  borne  up 

liSt. 

XXX  V. — Thomas  H — ,  aged  25,  a  tobacco-pipe  maker,  was  ad- 

mitted  to  St.  Mary's.  September  lf>th.  1>.">2.  having  sutl'ered  from  haemoptysis, 
cough,  and  other  phthisical  symptoms  for  sixteen  months,  during  which  time 
he  had  been  out-patient  to  the  Hrompton  and  other  hospitals.  There  appeared 
to  be  crude  tubercles  to  a  moderate  amount  at  the  apices  of  both  lungs.  !!<• 
complained  of  a  feeling  of  coldness  at  the  epigastrium,  which  inciva 
pain  after  meals  when  they  consisted  of  meat.  He  had  also  frequent  vomit- 
in  ir:  even  the  broth  diet  of  the  hospital  brought  it  on.  Hydrocyanic  Acid 
checked  it  u  little,  and  Bismuth  also  seemed  to  deaden  the  pain  iu  the  B] 
trium.  so  that  he  gained  a  pound  or  so  in  weight,  in  spite  of  what  we  thought 
ning  of  the  tubercles  under  the  left  clavicle.  He  was  able  to  digest 
fish  with  Irs*  pain  than  meat. 

1  Miring  this  time  hi*  father  was  ill  at  home  with  the  same  complaint  as  oar 
patient,  and  on  October  l.'.th  he  had  news  of  his  death.  He  was  much  affected. 
but  the  special  symptom*  did  not.  seem  aggravated,  ami  he  left  the  ward  for 
ln'iiie  at  his  own  desire  next  iimrniiiLr.  Two  days  afterwards  he  died  quite 
suddenly;  and  the  immediate  <-au«e  nf  decease  was  reported  by  his  friends  to 
have  been  grief  ut  the  loss  of  his  father. 

Ill  this  case  it  i.s  to  be  1   that  vomiting  was  pn- 


58  INDIGESTION    OF    VARIOUS    FOODS. 

which  is  a  grave  symptom.     Its  connection  with  phthisis  shall 
be  discussed  in  the  special  chapter  to  be  devoted  to  that  subject, 

Other  local  morbid  conditions  besides  those  of  the  stomach 
will  sometimes  cause  indigestion  of  meat  especially  of  all 
victuals. 

CASE  XXXVI. —In  February,  1849,  Mr.  K—  came  up  from  Wiltshire  to 
be  under  my  care.  His  complaint  was  of  vomiting,  especially  of  meat.  The 
morsel  seemed  to  stick  at  the  back  of  the  sternum,  to  cause  a  boiling  and  a 
gurgling  there,  and  to  be  rejected,  apparently  without  arriving  at  the  pit  of 
the  stomach.  He  was  much  reduced  in  strength  and  flesh  by  this  enforced 
abstinence  from  meat.  A  fair  trial  of  Prussic  Acid  was  made  without  success. 
But  a  drachm  of  Bismuth  three  times  a  day  deadened  the  morbid  sensibility 
of  the  part  affected  so  far,  that  he  was  able  to  swallow  meat,  considered  him- 
self cured,  and  returned  home. 

Here  I  felt  no  doubt  that  the  seat  of  injury  was  in  the 
oesophagus,  which  for  some  reason  or  another  rebelled  against 
conveying  meat. 

I  suspect  that  it  is  the  form,  rather  than  the  chemical  con- 
stitution, of  mammalian  muscular  fibre  which  causes  it  to  be 
objectionable.  For  in  the  following  case  we  were  enabled  to 
get  animal  food,  reduced  to  a  liquid  shape,  conveyed  past  a  sore 
spot  as  easy  as  vegetable. 

CASE  XXXVII.— Elizabeth  S— ,  aged  25r  died  at  St.  Mary's,  March  3d, 
1852,  of  an  ulcer  of  the  oesophagus  perforating- the  pericardium.  She  had 
been  in  the  ward  since  January  23d,  and  during  that  time  a  great  variety  of 
articles  of  diet  had  been  tried,  to  find  which  easiest  would  pass  into  the 
stomach.  Meat  she  could  never  swallow  at  all,  but  eggs  beaten  up  with  wine 
and  thick  cocoa,  she  could  retain  better  than  even  quite  fluids.  And,  indeed, 
for  some  time  before  the  accident  which  caused  death,  she  got  a  good  deal  of 
nutriment. 

Even  the  friability  of  the  fibre  will  make  a  difference.  Thus 
in  the  case  of  Thomas  H.,  quoted  page  57,  it  is  noted  that  fish 
could  be  borne  though  red  meat  was  not.  I  cannot  lay  my 
hand  on  another  similar  case,  but  the  idea  is  familiar. 

Yet  there  are  cases  when  the  very  softest  animal  food  is 
objected  to  as  experimentally  proved  to  cause  pain. 


INDIGESTION    OF    VARIOUS    FOODS.  59 

XXX  VIII      In  Oct.. l.i  T.  I-"-.  Mr.  George  R— ,  aged  54,  first  came 
under  my  chapjc.     He  wa-  'y  thin  and  miserable  to  look  at,  bnt  I 

could  novcr  discover  any  organic  disease  in  any  part.  He  said  that  from  a 
boy  lie  had  never  been  able  to  eat  animal  food  without  great  consequent  pain. 
Fluid  or  liquor  made  no  difference.  "Even  an  egg,"  he  said,  caused  it.  and 
often  brought  on  eructations  of  sulphuretted  hydrogen,  though  taken  in 
small  quantities.  He  has  often  constipation  with  severe  headaches.  There 
was  slight  pain  on  pressure  of  the  pyloric  region  of  the  epigastrium,  a  very 
white  (nervous)  tongue,  and  a  red  nose.  What  had  especially  troubled  him 
lately  was  an  impression,  whenever  he  attempted  to  eat  meat,  that  there  was 
a  pin  in  it.  He  was  always  quite  aware  that  it  was  a  delusion,  but  still  could 
not  shake  it  otT.  He  had  never  l>een  a  spirit-drinker,  nor  a  taker  of  medical 
drugs;  though,  like  most  dyspeptics,  he  had  given  homoeopathy  a  trial.  I 
-inc.  by  the  use  of  which  he  had  gained  a  little  weight  before 
he  left  town.  I  saw  him  again  next  August,  with  respect  to  an  eruption  of 
purpura  on  the  legs,  and  he  said  his  old  failings  had  got  much  better,  though 
he  could  not  quite  shake  off  the  fancy  about  the  pin. 

The  habitual  indigestion  of  meat  is  allied  to  the  indigestion 

of  fat.     There  are  transitional  cases  between  the  two,  that  is  to 

uses  where  there  is  partial  indigestion  of  both,  when  taken 

in  the  slightest  excess,  or  in  certain  forms,  but  no  very  glaring 

ivenience  or  illness  under  usual  circumstances.     We  find, 

for  instance,  people  who  can  eat  mutton  easily,  but  not  beef. 

Xo\\-  the  main  difference  between  mutton  and  beef  lies  in  the 

infiltration  of  the  bundles  of  muscular  fibres  by  fat.     Some  of 

•  persons  are  close  observers  enough  even  to  find  that  they 

can  eat  beefsteak,  but  not  roast  beef,  which  difference  is  capable 

of  a  similar  explanation.     Perhaps  the  entire  absence  of  fat  in 

fish  may  be  a  part  reason  why  it  also  is  easier  digested. 

SECTION   III. 
Indigestion  of  Fat. 

The  ili,Lr«'.-tion  of  fat  is  quite  independent  of  the  salivary  and 
i<;  fluids:.     11.  iir,-.  even  when  they  are  in  a  morbid  con- 
dition, ami  when  the  digestion  is  so  slow  that  the  meals  are 
detained  Ion;.'  enough  f(>r  the  fermentation  set  up  to  extend  itself 
to  the  lattv  matters  present,  ami  to  develop  butyric  and  other 
oily  acids,  .-till  sufficient  fat  is  digested  to  keep  up  the  nutrition 
of  that  tissue   in   the  body.     Nay.  patients  with   indigestion   of 
i  and  albumen  will  sometimes  even  get  o'  !y  if 

'.  specimens  may  be  found  in  this  volume. 


60  INDIGESTION    OF    VARIOUS    FOODS. 

The  most  familiar  instance  of  the  indigestion  of  fat  is  found 
in  that  disease  which  gets  its  name  from  the  characteristic  phe- 
nomenon arising  out  of  that  indigestion — Phthisis.  In  tuber- 
cular consumption  the  body  wastes  away,  cot  because  of  the 
destruction  of  fat  being  increased,  but  because  of  its  renewal 
being  arrested. 

Its  renewal  is  arrested  primarily  and  directly  by  any  disease 
which  affects  the  ilia,  such  as  diarrhoea  especially,  because  the 
ilia  are  the  immediate  instruments  of  its  absorption;  secondarily 
by  the  inefficiency  of  the  secretions  which  assist  in  its  solution 
and  alkalization,  such  as  the  pancreatic  juice  and  bile;  in  a  less 
degree  by  the  colonic  or  fecal  viscera;  and  by  the  other  organs 
of  the  body  just  in  proportion  as  they  influence  indirectly  these. 
As  illustrations  of  the  agency  of  its  renewal  and  non -renewal, 
compare  the  following  cases. 

CASE  XXXIX. — In  September,  1857,  I  was  called  to  see  Mrs.  B — ,  aged 
45,  reported  as  in  an  incipient  stage  of  consumption.  There  were  old  scrofu- 
lous scars  in  her  neck,  and  apparently  a  moderate  deposit  of  tubercle  in  both 
pulmonary  apices,  indicated  by  bronchial  breathing  under  each  clavicle,  and 
by  sibilant,  occasionally  crepitant  rales  on  the  left  side.  This  did  not  seem 
to  account  for  the  emaciation,  and  anatomically  justified  the  diagnosis  of 
incipiency.  But  it  appeared  that  she  had  tried  to  take  Cod-liver  oil  and 
failed ;  and  that  the  cause  of  the  failure  was  its  induction  of  diarrhoea ;  so 
that  the  more  she  took  the  thinner  she  got.  Also  after  every  meal  which 
included  the  smallest  quantity  of  any  fatty  matter  diarrhoea  followed.  The 
stools  were  like  peasoup,  and  when  she  was  taking  the  Cod-liver  oil,  drops  of 
the  oil  used  to  be  seeu  floating  on  the  surface  of  them.  Attempts  to  change 
this  condition  failed,  and  she  never  got  any  better,  I  know,  though  I  did  not 
attend  her  to  the  last. 

CASE  XL. — Ellen  L — ,  an  ill-starred  orange-girl  in  her  19th  year,  left  alone 
in  the  world  from  all  her  relations  having  died  of  consumption,  came  into  St. 
Mary's  Hospital,  January  8th,  1856,  in  the  third  stage  of  the  same  disease. 
Indeed  she  had  been  an  invalid  long  enough  for  the  catamenia  never  to  have 
appeared,  being  probably  arrested  by  her  ill-health.  She  was  a  flabby-faced, 
strumous-looking  girl  with  grayish-brown  eyes,  much  emaciated,  and  with  the 
finger-nails  curved  into  claws.  She  had  much  cough  with  blood-tinged  ex- 
pectoration, for  which  she  had  been  in  several  hospitals,  always  with  relief. 
The  upper'part  of  the  left  ribs  was  flattened,  and  there  was  that  large  crepi- 
tation and  metallic  bubbling  to  be  heard  which  distinguishes  a  vomica,  while 
at  the  right  apex  there  was  fine  crepitation  with  tubular  breathing.  She 
rested  but  little,  and  the  lips  were  livid  from  the  imperfect  aeration  of  the 
blood  in  the  obstructed  pulmonary  tissue. 


INDIGESTION    OF    VARIOUS    FOODS.  61 

was  anxious  to  come  into  the  hospital,  because  she  liked  Cod-liver  oil, 

took  it  -with  a  relish."  and  -rot  better  on  it.    Her  bowels  were  always  costive. 

.  inly  did  improve  on  Cod-liver  oil  and  Quinine.     Her  hectic  abated. 

she  got  a  good  appetite  ;  the  pulse  was  fuller,  and  she  lost  her  cough.     So  at 

her  own  request  she  returned  to  her  occupation  on  February  10th. 

XL!.--  In  April.  lK">s,  I  met  in  consultation  Dr.  C.  IJ.  Williamson 
tin-  case  of  Alice  ('— .  aijed  14,  who  we  made  out  to  have  a  small  amount  of 
tubereiilar  <  ;he  apex  of  one  lung,  and  in  the  bronchial  glands  adjoin- 

-he  had  a  great  deal  of  cough,  and  was  much  emaciated.     Up  to  that 
iie  had  lii-eii  most  carefully  attended  to  and  actively  treated.     Blisters, 
Iodine.  Iron,  tonics,  had  been  assiduously  administered.     Having  made  our 
:<>te  out  a  prescription  of  numerous  materials  in  accordance 
with  the  orthopraxy  of  the  day.     During  the  performance  of  this  duty,  I  re- 
membered that  I   had  seen  our  patient  (who  was  the  daughter  of  an  intimate 
friend)  at  luncheon  eating  some  fat  mutton,  and  it  struck  me  that  this  capa- 
bility had  never  received  full  play.      When,  then,  the  prescription  was  written 
I  proposed  that  it  should  be  put  away  for  six  weeks,  and  the  patient  have  no 
.ue  at  all.  except  whatever  she   fancied  to  eat.     It  was  a  struggle  to 
a  good  prescription,  but  yet  that  was  agreed  to,  and  in  the  six  weeks  so 
much  pro_  made  by  change  of  air,  and  scene,  and   diet,  that  the 

father  declared  that  had  she  taken  three  globules,  to  those  three  globules  he 
could  ii"t  but  have  attributed  the  cure.  This  was  eight  years  ago,  the  patient 
a  sea  voyage,  and  is  careful  during  the  winter;  the  air  does 
not  enter  her  left  apex  so  well  as  the  right,  and  she  is  shortish  of  breath  ;  but 
she  run.*,  and  ri«ie.-.  and  hunts,  and  dances,  and  has  plenty  of  flesh  on  her 

II. — Just  after  Lady-day,  1861,  Harriet  B — ,  a  maiden  lady,  aged 

30,  whose  "  father  and  mother  had  both  died  of  decline,"  was  pl.iccd  under 
.re  by  Dr.  liuckell  of  t'hichester.  She  had  evidence  of  a  small  focus  of 
tubercle  in  the  apex  of  the  left  lung,  producing  pain,  dulness,  and  crepitation 
(from  the  partial  condensation  of  the  lung  round  it),  but  no  marked  pulmo- 
nary ailment.  1  thought  that  the  quantity  of  tubercle  was  slowly  iuci- 
from  week  to  week.  What  she  complained  of,  however,  was  emaciation  and 
diarrhn-a,  accompanied  by  the  passage  of  pus  and  sometimes  streaks  of  blood 
iu  the  inn.  She  was  soon  relieved  uf  this  by  appropriate  rem- 

and with  a  store  of  ll.i.-matox\lum  and  Copper  was  able  to  go  on  a  long 
summer  visit  to  some  country  cousins.  I  heard  of  her  as  going  on  well,  and 
did  not  expert  to  M-e  h.-r  again,  or  to  inak-  available  for  science. 

l»ut  a-  .-he  returned  through  London  in  September,  proclaiming  lu-r>clf  quite 
stout  and  hearty,  I  had  an  opportunity  of  examining  her  clu-.-t  a-jaiu.  I 
could  then  detect  by  neither  percu.--ion  nor  the  ear  any  di-.-a.-e  at  all  in  the 
lun-_'-.  The  pulmonary  tubercle  had  become  dormant.  Two  years  afterwards 
I  saw  her  walking  briskly  through  the  .-tree!.-,  looking  well. 

1  XI. 111.     -1.  I'..  1'—,  aged  twenty-,  -i^'nt.  and  actively  engaged  in  retail 

buMiic.-s  when  well  enough,  was  put   under  i;,  .     The 

history  given  me  by  h;.-  medical  man  (Mr.  fcskaife  of  Northampton  .Square) 


62  INDIGESTION    OF    VARIOUS    FOODS. 

was  as  follows.  He  had  been  a  great  consumer  of  beer,  but  always  in  fair 
health  till  the  beginning  of  1865,  when  he  began  to  pass  uric  acid  gravel  in 
his  urine.  This  continued  a  year,  when  by  dint  of  careful  dieting  it  was 
cured.  In  the  spring  of  1866  he  had  a  dysenteric  diarrhoea,  passing  in  the 
stools  a  great  quantity  of  mucus  and  occasionally  blood  for  many  weeks.  He 
was  seen  several  times  by  Dr.  Brinton  in  consultation  with  Mr.  Skaife,  and 
cured  by  Alkalies.  This  diarrhoea  reduced  him  excessively,  so  that  he  lost 
nearly  two  stone  in  weight.  He  regained  his  weight,  and  continued  well  till 
December,  when  he  began  to  cough,  and  was  troubled  a  good  deal  with  that 
symptom.  In  the  morning  he  expectorated  transparent  mucus  with  it,  but 
during  the  day  it  was  dry.  Then  he  began  to  sweat  of  nights,  and  again 
rapidly  to  lose  weight.  So  that  during  the  six  weeks  before  I  saw  him  he 
had  lost  fifteen  pounds,  the  loss  being  very  often  as  much  as  half  a  pound 
daily,  at  which  rate  it  was  then  going  on. 

The  rapidity  of  the  emaciation  drew  attention  to  the  urine,  which  I  found, 
after  exertion  during  the  day,  clear,  full-colored,  free  from  albumen  and  sugar, 
and  of  the  specific  gravity  1.027. 

The  chest  was  narrow  and  did  not  expand  freely.  It  was  normally  reso- 
nant. Scattered  about,  in  the  upper  lobes  especially,  there  were  spots  in 
which  a  full  inspiration  revealed  crackles  and  occasionally  interrupted 
("  wavy")  breath  sounds. 

There  was  extreme  slowness  of  digestion,  especially  of  flesh  food,  and  espe- 
cially at  the  later  periods  of  the  day.  Between  three  and  four  hours  after  a 
meal  he  would  have  eructations  of  nauseous  taste  and  smell  like  rotten  eggs. 
The  quantity  taken  made  no  difference ;  they  followed  a  light  snack  as  often 
as  a  heavy  dinner.  His  appetite  was  fair,  but  yet  he  could  not  eat  more  than 
two  meals  a  day  on  account  of  these  eructations.  For  they  were  brought  on 
by  anything  solid  or  liquid  he  took  after  a  two  o'clock  dinner.  Supper  espe- 
cially he  could  never  take,  though  he  had  tried  all  sorts  of  victuals.  The 
attempt  kept  him  awake  all  night  with  flatulence  upwards  and  downwards 
and  feverishness.  The  bowels  acted  naturally,  but  the  stools  were  apt  to  be 
fetid. 

I  prescribed  for  him  g^th  of  a  grain  of  Strychnia  and  2  grains  of  Quinine 
twice  a  day,  and  a  bottle  of  claret  for  drink,  mixed  diet  and  no  tea  or  supper 
at  present. 

On  February  6th  his  weight  had  become  quite  stationary,  none  having  been 
lost  since  he  began  the  treatment.  The  specific  gravity  of  the  morning  urine 
was  1.022.  The  night  sweats  were  much  diminished  and  he  felt  stronger 
altogether.  So  much  so  indeed  that,  visiting  a  friend's  gymnasium  on  the 
4th,  he  tried  his  hand  at  raising  a  weight  by  a  pulley.  This  exertion  was  fol- 
lowed the  next  day  by  severe  pain  between  the  sternum  and  left  shoulder, 
which  remained  at  the  time  of  his  coming  to  me.  On  examination  it  appeared 
due  to  tenderness  at  the  insertions  of  the  pectoral  muscle  in  the  ribs. 

A  fortnight  afterwards  he  had  gained  six  pounds  in  weight,  and  on  the  8ih 
of  March  a  pound  and  a  half  more.  On  the  25th  of  March  he  was  stationary 
in  that  respect.  The  night-sweats  had  diminished  to  a  mere  dampness  during 


INDIGESTION    OF    VARIOUS    FOODS.  63 

ond  or  morning  sleep.    He  was  able  to  take  meat,  sometimes  fat  meat, 

.i  day.  ami  toasU-d  cheese,  without  the  nidorous  eructations  which  for- 
merly followed. 

lit-  was  alarmed,  it  is  true,  by  the  appearance  in  the  urine  of  some  fine 
pow.Ii-ry  ml  deposit,  which  on  examination  proved  to  be  uric  acid;  and  he 
doubted  about  tin- wisdom  of  continuing  the  hi^h-feedim:.  I»ut  I  pointed  out 
how  much  rather  to  be  chosen  it  is  than  the  emaciation,  which  had  been  really 
on  the  verge  of  currying  him  to  the  grave;  and  to  overcome  Bordered  some 
Hydrochloric  acid  instead  of  Citric  as  a  solvent  for  the  Quinine. 

Ol. serve  the  difference  between  these  patients  (not  picked 
it  such  as  are  constantly  occurring),  and  observe 
wherein  it  lies.  In  the  power  of  assimilating  fat.  The  first 
had  not  the  power,  and  lost  her  life  with  enough  healthy  lung 
in  her  chest  to  have  lasted  her  for  many  years;  the  second  had 
the  power  in  extraordinary  force,  so  that  she  was  able  to  take 
an  excessive  quantity  of  oleaginous  nutriment,  and  so  to  bear 
up  for  a  time  against  a  most  formidable  amount  of  softening  de- 
structive tubercle;  the  third  had  not,  indeed,  any  extraordinary 
power,  but  she  had  less  amount  of  disease  to  bear,  and  she  bore 
it ;  the  fourth  and  fifth  .had  lost  the  power,  but  regained  it,  and 
with  it  overcame  the  morbid  diatl 

It  is  truly  by  aid  of  the  digestive  viscera  alone  that  con- 
sumption can  be  curable.     Medicines  addressed  to  other  parts 
lie  indirectly  useful  sometimes,  but  they  more  commonly 
impede  the  recovery  ;   whereas  aid  judiciously  given  in  this 
quarter  is  ahvavs  beneficial  and  often  successful. 

The  chest  is  tin-  battle-field  of  past  conflict,  the  lymphatic 
duct  the  drill-ground  lor  new  levies  of  life. 

Remark  in  the  orange-girl  the  costiveness  and  the  amenor- 
rlio'u.  I>oth  of  these  are  good  things  in  consumption.  I  do 
not  mean  good  signs,  which  they  are  not,  but  advantageous  in 
tin-  prolongation  of  life.  Fur  in  such  a  condition,  the  lat  taken 
in  is  not  exhausted  by  even  the  natural  drain — abnormally 
requisite  it  is  abnormally  retained. 

Th-  of  Cod-liver  oil  1>  ;;nd  less  a  marvel  the 

6  we  know  of  physiology.     The  instinctive  de-ire  -hown 

by  all  nations  for  an  oleaginous  dirt,  and  their  association  of 

Mnces  of  this  nature  with  proverbial  ideas  of  happin> 
all  ages,  show  the  value  of  a  certain  amount  of  it    to  man's 


6i  INDIGESTION    OF    VARIOUS    FOODS. 

comfort.  The  "butter  and  honey"  of  the  prophet,  used  as  a 
phrase  for  royal  food,  and  the  constant  reference  in  the  Bible 
to  oil  as  a  luxury  (though  it  could  have  been  no  rarity  in  "a 
land  of  oil-olive") — these  are  sufficient  to  prove  its  estimation 
among  the  Hebrews.  The  Hindoo  laborer,  when  he  devours 
his  gallon  of  rice  for  a  meal,  will  spend  all  the  pice  he  can  get 
on  the  clarified  butter  of  the  country;  and  "as  good  as  ghee!" 
is  his  expression  of  unqualified  admiration.  It  was  a  mistake 
in  Baron  Liebig  to  state  that  oily  foods  are  disgustful  to  natives 
of  hot  climates.  All  races  of  men  require  them  and  seek  after 
them;  and  the  taste  of  the  Esquimaux,  so  often  quoted,  depends 
mainly  on  the  abundant  supply  of  the  article  which  the  sea 
places  at  his  disposal,  coupled  with  a  scantinesss  of  other  pro- 
visions. Throughout  mankind  there  is  an  instinctive  apprecia- 
tion of  the  importance  of  this  aliment,  independent  of  accidental 
differences  of  nation  or  locality.  It  seems  felt  to  be,  as  science 
shows  that  it  really  is,  a  necessary  material  for  the  renewal  of 
the  tissues,  and  the  desire  for  it  becomes  synonymous  with  a 
desire  for  augmented  life. 

An  easily  assimilated  oil  comes,  in  fact,  into  the  short  list  of 
directly  life-giving  articles  in  the  pharmacopoeia;  for  it  is  itself 
the  material  by  which  life  is  manifested.  Hence,  under  its  use, 
beneficial  influences  are  exerted  throughout  the  whole  body ; 
old  wounds  and  sores  heal  up ;  the  harsh  wrinkled  skin  regains 
the  beauty  of  youth;  debilitating  discharges  cease,  at  the  same 
time  that  the  normal  secretions  are  more  copious ;  the  mucous 
membranes  become  clear  and  moist,  and  are  no  longer  loaded 
with  sticky  epithelium ;  the  pulse,  too,  becomes  firmer  and 
slower — that  is  to  say,  more  powerful,  for  abnormal  quickness 
here  is  always  a  proof  of  deficient  vitality.  Such  are  the  effects, 
perfectly  consistent  with  physiology,  of  supplying  a  deficiency 
of  molecular  base  for  interstitial  growth.1 

But  that  supply  is  useless  unless  the  absorbents  are  fit  to 
take  it  up,  unless  they  are  prepared  (as  the  fourth  case)  by 
proper  tonics  for  its  reception. 

To  find  the  easiest  assimilated  oil,  and  to  prepare  the  diges- 

1  See  "Lectures,  chiefly  Clinical,"  by  the  author,  p.  275,  &c. 


INDIGESTION    OF    VARIOUS    FOODS.  65 

tion  for  the  absorption  of  oil,  are  the  main  problems  in  the  cure 
of  consumption. 

Closely  allied  to  this  condition  is  what  is  called  in  children 
"  strumous"  or  "  rickety"  dyspepsia,  because  it  leads  to  struma 
and  rickets.  Cases  are  commop  enough  among  the  ignorant 
and  the  poor.  The  following  includes  as  many  of  the  ordinary 
typical  symptoms,  and  as  few  individual  peculiarities  as  any  I 
could  select : — 

X  LIV. — James  A — ,  aged  7,  admitted  to  St.  Mary's,  August  9th, 
1856,  had  an  angular  countenance  of  grave  expression,  with  gray  eyes  and 
long  fringed  eyelashes.  The  veins  of  the  eyelids  and  temples  were  large  and 
conspicuous.  The  arms  and  legs  were  very  attenuated,  in  strange  contrast 
with  the  swelled  and  drummy,  but  flaccid,  belly,  on  which  also  the  parietal 
veins  were  enlarged.  The  skin  of  the  limbs  was  dry  and  unrenewed,  giving 
them  a  dirty  look.  In  bed  he  was  restless,  picking  his  nose,  rubbing  his  anus, 
fitl;rr ting  his  head  about,  kicking  off  the  clothes,  and  getting  inU)  all  sorts  of 
odd  postures ;  but  when  dressed  he  was  preternaturally  grave  and  quiet,  and 
crii-d  when  he  was  roughly  touched  by  any  one.  He  ground  his  teeth  and 
perspired  profusely  when  asleep. 

Though  so  thin,  he  was  said  to  have  a  ravenous  appetite.  His  tongue  was 
pinkish  with  white  spots;  he  was  thirsty.  His  stools  were  copious,  pale 
colored,  as  if  entirely  deficient  in  bile;  with  inky  stains  in  parts,  as  if  Iron 
had  been  taken,  which,  however,  was  denied.  There  were  no  worms  in 
tli-  in.  though  the  presence  of  these  parasites  had  been  reported.  Their 
smell  was  very  nauseous,  resembling  that  of  the  macerating-tub  of  a  dissect- 
ing-room. 

I  Miring  a  fortnight  that  he  was  in  hospital,  the  stools  became  natural  under 
the  use  of  purgatives,  Iron,  and  meat ;  and  in  close  ratio  to  the  improvements 
of  the  stools,  was  the  patient's  increase  of  flesh. 

Examination  by  the  microscope  of  stools  like  those  shows 
them  to  contain  lumps  of  unaffected  muscular  fibre,  undissolved 
i'at,  and  free  oil-globules  in  great  quantity.  In  such  quantity, 
indeed,  that  their  whitish  color  might  really  be  due  to  the 
emulsioned  oil.  Fat  is  here  taken  down — truly  "down"  to 
chemical  decay;  but  not  taken  up — up  to  living  tissue — by 
the  lympliat 

The  passage  of  free  oil  shows  the  imperfect  action  of  the  in- 

the  lumps  of  fat  the  imperfect  action  of  the  stomach. 

Dr.  E.  Schroder  found  that  in  the  healthy  stomach  of  a  woman 

with  gastric  fistula,  adipose  tissue  which  was  swallowed  became 

so  far  disintegrated  that  the  oil  was  freed  from  the  areolar  sacs 

5 


66  INDIGESTION    OF    VARIOUS    FOODS. 

which  contained  it,  united  into  drops,  and  floated  free  in  the 
fluids  around  it.1 

In  the  already  quoted  cases  there  has  been  no  deficiency  of 
appetite.  Fat  is  swallowed,  but  is  not  absorbed.  And  this 
would  seem  to  depend  on  the  fault  of  the  lower  part  of  the  in- 
testinal canal,  of  the  intestines  with  their  lymphatic  vessels. 
In  other  patients  there  is  found  a  disgust  to  fat  and  to  all  that 
contains  it  so  great  as  to  induce  nausea  when  the  attempt  is 
made  to  force  the  inclination.  In  these  it  seems  to  me  probable 
that  the  upper  parts  of  the  digestive  apparatus,  and  especially 
the  pancreas,  whose  duty  is  the  emulsification  of  fat,  are  to 
blame.  The  nausea  often  takes  the  aspect  of  repugnance  to 
meat,  for  all  flesh  is  scented  by  its  own  peculiar  adipose  tissue, 
and  owes  to  that  its  distinctive  odor,  which  is  unavoidably 
associated^in  the  mind  of  the  patient  with  the  meat  itself. 

CASE  XLV. — Miss  A.  M — ,  aged  20,  was  first  placed  under  my  care  No- 
vember 3d,  1865.  She  was  excessively  emaciated,  the  cheeks  were  hollow, 
the  abdomen  fell  in  so  that  the  first  thing  you  felt  on  pressing  it  was  the 
spine,  and  the  haunch  bones  stuck  up  like  the  arms  of  a  chair.  The  space 
made  dull  by  the  liver  on  percussion  was  very  small.  The  skin  of  the  body 
was  harsh  and  dry.  The  bowels  were  excessively  costive,  not  having  acted 
for  years  without  strong  purgatives  or  laxative  enemata.  The  mind  was  un- 
naturally quiet  and  retiring ;  she  avoided  speaking  of  her  ailments,  and  would 
go  and  cry  in  solitude  if  pestered  about  them.  She  expressed  an  excessive 
disgust  to  animal  food,  especially  if  moist  or  savory.  The  only  chance  of 
getting  her  to  eat  a  bit  of  meat  was  to  have  it  so  dried  up  that  most  people 
would  refuse  it.  There  was  no  hallucination  or  morbid  fancy  about  her  diet, 
but  she  persisted  that  she  had  severe  headaches  and  pain  in  the  abdomen  after 
it,  till  such  time  as  it  was  removed  by  action  of  the  bowels.  Cod-liver  oil, 
which,  naturally,  a  medical  man  had  ordered  for  her,  had  caused  such  ex- 
cessive nausea  and  vomiting,  that  it  was  impossible  to  persist  in  it.  She  had 
a  craving  for  alcoholic  stimulants.  With  all  her  atrophy  the  color  had  not 
left  her  cheeks,  the  lips  were  full  and  red,  and  she  retained  a  peculiar  delicate 
style  of  beauty  like  a  hectic  consumptive.  The  urine,  too,  was  of  a  natural 
quantity,  color,  and  smell,  and  of  the  mean  specific  gravity  of  1.018.  So 
there  was  naught  of  what  could  be.  called  anaemia.  The  muscles,  too,  were 
well  nourished  and  innervated,  so  that  she  could  walk,  and  would  walk  if 
permitted,  more  than  was  prudent ;  and  it  was  after  these  exertions  that  she 
used  to  urgently  ask  for  wine.  The  heart  and  lungs,  whose  sounds  and 

1  Succi  Gastric!  Human!  Vis  Digestiva,  &c.,  auctore  Ernesto  de  Schroder. 
Dorpati,  1853,  p.  30. 


IXDIGESTIOX    OF    VARIOUS    FOODS.  67 

motions  the  skeleton  condition  of  the  chest  exhibited  with  anatomical  dis- 
tinctness, were  i|iiiti>  healthy. 

The  only  ana-rnia  was  amenorrhoea,  which  had  existed  for  eight  months. 

The  hi-tory  was  derived  from  a  most  kind  and  observant  step-mother.  It 
appeared  that  Miss  M — and  her  sisters  had.  during  their  father's  widowhood, 
been  under  the  care  of  a  horrible  French  school-mistress,  who  with  a  sort  of 
wickedness  conceived  a  hatred  to  the  family,  and  actually  tried  to 
starve  them  to  death  to  spite  the  father.  One  died,  but  the  circumstances 
were  so  painful,  that  I  could  not  cross-examine  into  particulars.  The  elder 
ones  are  alive  and  hearty.  And  this  one  seemed  to  get  quite  strong.  She  was 
plum]*,  and  the  catamenia  came  on  at  sixteen.  But  soon  after  that  she  began 
to  full  into  her  present  condition,  and  the  catamenia  ceased,  as  above  stated, 
gradually. 

She  had  tried  vegetable  tonics,  Iron,  mineral  acids,  baths,  hydropathic 
packing,  homoeopathic  remedies,  &c.  &c.,  without  consequent  benefit  or  injury, 
so  far  as  I  could  discover.  Also,  in  passing  from  one  hand  to  another, 
usually  the  purgatives  were  increased  in  intensity  and  variety.  Her  father, 
a  physician,  was  growing  sceptical  of  his  profession. 

I  commenced  treatment  by  leaving  off  all  purgatives  and  giving  her  un- 
known to  herself.  Opium  in  half-grain  doses,  with  a  view  of  stopping  the  pain, 
which  she  said  she  always  had  when  the  bowels  were  not  open.  I  took  it  to 
be  an  abnormal  sensibility  of  the  intestinal  canal,  which  would  not  allow  the 
requisite  food  to  lie  there  a  sufficient  time.  In  such  a  case  the  orthodox 
"  bowels  open  once  a  day"  is  a  diarrhoea.  This  plan  was  successful,  for  with 
the  exception  of  warm-water  enemata  twice  a  week  during  the  winter,  she 
had  taken  no  purgatives  since,  and  now  the  bowels  are  open  of  their  own 
accord,  and  the  Opium  pills  are  left  off. 

I  irave  her  Pepsine,  which  seemed  quite  inert;  and  then  Strychnine,  which 
brought  back  the  pain  and  curiously  prostrated  her.  It  was  bad  practice. 

1  have  already  said  Cod-liver-oil  was  out  of  the  question. 

On  .January  17th  I  began  to  educate  her  gradually  to  use  Dobell's  Pan- 
creatic Kmulsion,  and  she  has  continued  to  take  from  one  to  three  doses 
daily  ever  since.  I  hear  of  her  from  time  to  time  as  slowly  improving;  any 
acquaintance  who  have  not  seen  her  for  several  weeks,  invariably  remark  on 
her  gain  of  flesh.  The  appetite  is  better,  and  the  bowels  open  naturally  three 
or  four  times  a  week.  (July  Gtk,  18G6.) 

Remark  how  the  deficiency  in  the  assimilation  of  fat  (induced 

ably  l»y  tin.-  starving  alluded  to,  though  not  assigned  to  that 
by  thf  narrator)  made  no  sign  In 'fore  puberty.  Up  to  that  period 
apparently  enough  had  been  taken  in  for  the  ordinary  purposes 
of  life,  but  after  it  the  supply  was  insuflieient  and  the  failure  in 
health  followed  accordingly. 

What  lias  puberty  to  do  with  fat  ?  Certainly  something  :  in 
normal  health  girls  In-fore  the  change  naturally  dislike  fat,  but 
afterwards  take  to  it  instinctively.  Under  ordinary  circuni- 


68  IXDIGESTIOX    OF    VARIOUS    FOODS. 

stances  and  with  the  restraints  which  society  teaches  us  to  lay 
on  our  appetites,  especially  in  youth,  the  instincts  are  scarcely 
made  apparent ;  but  accidental  occurrences  will  sometimes  ex- 
hibit their  existence  in  a  somewhat  unsuspected  manner.  The 
following  anecdote  shows  what  a  strongly  marked  line  can  be 
drawn  between  the  child  and  the  woman  in  their  relish  for  food, 
and  how  full  development  is  not  exhibited  in  this  or  that  organ 
exclusively,  but  in  the  whole  person  simultaneously.  It  was 
narrated  to  me  by  the  chief  actor. 

CASE  XLYI. — In  1825  or  '26  the  late  Mr.  Kidout,  a  much  respected  surgeon 
in  the  neighborhood  of  Russell  Square,  was  summoned  to  St.  Albans,  to  see 
the  apprentices  who  to  the  number  of  sixty  were  employed  in  the  Abbey 
silk-mills  at  that  place.  A  great  number  of  the  inmates  of  the  house  were 
suffering  from  a  variety  of  obscure  symptoms  of  various  degrees  of  intensity. 
On  the  examination  of  the  invalids  he  arrived  at  the  suspicion  that  their 
illness  depended  on  the  poison  of  lead,  and  advised  their  being  treated  accord- 
ingly. In  the  mean  time,  specimens  of  the  water  were  reserved  for  analysis, 
the  milk-vessels  made  of  crockery  were  examined  for  the  metal  in  question ; 
but  nothing  deleterious  was  found,  nor  had  any  part  of  the  building  been  re- 
cently painted.  Still  fresh  cases  kept  occurring,  and  those  who  had  recovered 
relapsed,  and  had  colic  a  second  time.  The  cause  of  the  evil  was  evidently 
permanent. 

Now  the  surgeon  in  ordinary  attendance  had  been  loth  to  agree  to  the 
diagnosis  which  assigned  the  symptoms  to  lead-poison,  from  some  connection 
which  seemed  to  exist  between  the  occurrence  of  the  disorder  and  the  uterine 
functions.  Not  only  were  the  catamenia  arrested  in  those  attacked,  but  it 
was  observed,  that  all  the  girls  under  puberty  had  wholly  escaped,  while  all 
who  had  ever  menstruated,  from  the  maiden  of  fourteen  to  the  matron  super- 
intendent, were  affected  in  various  degrees. 

The  search  was  still  pursued  for  the  avenue  by  which  the  lead  had  entered 
the  system,  and  the  mystery  was  at  last  solved  on  probing  to  the  bottom  of  a 
salting  trough  in  which  fat  pork  was  kept.  It  was  found  to  be  lined  with  the 
deleterious  metal,  and  to  have  impregnated  the  outside  of  each  joint  with  the 
poisonous  carbonate.  Inquiries  were  then  made  of  the  apprentices  themselves 
for  some  link  which  would  connect  this  discovery  with  the  anomalous  escape 
of  some  parties,  and  injury  to  others. 

It  appeared  that  this  fat  pork  was  placed  on  the  table  three  times  a  week, 
but  never  alone,  being  always  accompanied  by  some  fresh  meat,  and  the  girls 
were  at  liberty  to  take  which  they  liked.  Now  on  questioning  them  it  came 
out,  though  not  previously  observed,  that  the  older  apprentices  and  adults 
always  ate  the  pork,  while  the  little  girls — all,  that  is,  under  puberty — invari- 
ably chose  mutton.  The  disease  which  had  attacked  the  one  and  spared  the 
others,  was  a  test  of  the  truth  of  the  statements  which  they  had  made. 


INDIGESTION    OF    VARIOUS    FOODS.  69 

The  newly-acquired  desire  for  fat  meat  at  the  age  of  puberty 
is  a  most  interesting  and  curious  fact.  It  is  more  observable  in 
the  female  sex,  from  the  deep  influence  on  the  vital  actions  of 
the  whole  individual  which  that  change  exerts  in  them,  but 
indications  of  the  same  thing  may  be  seen  in  boys.  How  shall 
we  associate  this  fact  with  what  we  know  of  the  other  corporeal 
functions  of  this  period  ?  The  mere  growth  of  the  body  in  size 
is  much  the  same  before  and  shortly  after  puberty.  Nor  is  it 
easy  to  conjecture  what  the  evacuation  of  the  catamenia  can 
have  to  do  with  oleaginous  matters. 

There  is,  however,  a  change  that  takes  place  in  the  excretion 

of  one  organ,  which  modern  chemistry  has  taught  us  to  allay  with 

the  chemical  changes  of  all  carboniferous  substances  in  a  strict 

and  peculiar  manner.     It  is  to  the  lungs  that  we  would  look  for 

-tance  in  explaining  the  circumstances  before  us. 

It  appears  from  the  researches  of  MM.  Andral  and  Gavarret,1 
that  the  excretion  of  carbonic  acid  by  the  lung  increases  in 
quantity  during  childhood  very  exactly  in  proportion  to  growth, 
the  augmentation  steadily  progressing  up  to  the  period  of  pu- 
berty. In  boys  it  would  seem  but  little  affected  by  that  new 
function ;  but  with  girls  the  case  is  entirely  different ;  there  the 
occurrence  of  menstruation  puts  a  complete  stop  to  the  increase 
in  the  amount  of  carbon  thus  passing  away,  and  sometimes  even 
causes  it  to  make  a  retrograde  movement.  Thus  a  child  of 
thirteen  years  of  age  exhaled  6.3  grammes  of  carbon  hourly;  a 
girl  of  fifteen  years  and  a  half,  who  had  not  menstruated,  7.1 
grammes;  while  another,  also  fifteen  years  and  a  half,  but  in 
whom  the  flow  was  regular,  gave  out  only  6.3,  the  same  quantity 
as  the  one  two  years  and  a  half  younger.  The  same  observation 
was  the  result  of  experiments  on  healthy  women  of  twenty-six, 
thirty-two,  and  even  forty-five  years  of  age,  who  still  continued 
to  experience  their  monthly  evacuations.  After  the  change  of 
life  has  occurred,  the  exhalation  of  carbonic  acid  begins  to  in- 
-o  again,  and  in  elderly  women  is  much  the  same  as  in 
elderly  men.  What  is  still  more  curious  is,  that  when  from 
either  pregnancy  or  illness  the  catamenia  are  stopped,  then 

1  "  Annales  de  Chiinie  et  de  Phys.,"  vol.  viii.  p.  129. 


70  INDIGESTION    OF    VARIOUS    FOODS. 

temporarily  the  pulmonary  excretion  is  augmented  and  occupies 
a  vicarious  position  in  respect  to  the  other  functions. 

The  uterus,  then,  and  vital  actions  which  are  expressed  by  it, 
play  an  important  part  in  the  decomposition  of  carbon  in  the 
system.  When  we  reflect  on  this,  changes  in  the  digestion 
which  supplies  that  carbon  and  changes  in  the  instincts  which 
supply  the  digestion  will  not  surprise  us,  when  they  accompany 
the  radical  alteration  which  the  generative  organs  experience 
at  puberty.1 

This  digression  has  been  so  long  that  it  has  taken  us  away 
from  the  patient  before  us.  The  chief  practical  point  of  remark 
is  the  importance  at  that  critical  period  in  woman's  life  of 
watching  over  the  digestive  organs,  especially  in  respect  of  their 
appropriation  of  fat,  then  so  eminently  necessary. 

A  condition  leading  to  the  non-assimilation  of  fat  may,  like 
other  kinds  of  indigestion,  be  brought  on  by  overstrain  of  the 
mind,  as  well  as  of  the  body ;  a  fact  of  the  utmost  importance 
in  tracing  the  history  and  applying  it  practically  to  the  cure  of 
the  patient. 

CASE  XLVII. — Miss  A.  D —  had  an  ambitious  intellectual  governess,  who 
finding  her  pupil  very  retentive  of  learning  and  persevering,  from  fourteen  to 
fifteen  pressed  her  forwards  in  her  education  with  great  energy.  The  nutri- 
tion of  the  mind  went  on,  that  of  the  body  was  stayed ;  she  was  very  sharp 
and  learned,  but  she  ceased  to  grow.  The  menses  appeared  for  once,  and 
never  again.  Tt  was  also  observed  that  she  loathed  her  food,  and  anything 
"rich"  (that  is,  greasy)  made  her  peculiarly  uncomfortable  afterwards,  so 
that  she  sometimes  threw  it  up.  Her  temper  became  queer  and  her  conscience 
fanciful,  and  she  distressed  herself  needlessly  about  her  failing  powers  of  ob- 
servation and  work.  It  was  noticed  too  that  sometimes  in  reading  a  kind  of 
cataleptic  stiffness  would  come  over  her  ;  she  stopped  for  a  minute  or  so  as  if 
a  parenthesis  was  snipped  out  of  existence,  and  then  went  on  with  her  em- 
ployment, unconscious  for  the  most  part  that  anything  out  of  the  way  had 
happened. 

By  rest  and  quiet  treatment  her  wish  for  food  returned,  but  still  she  got 
more  and  more  emaciated,  so  that  at  seventeen  Dr.  Gibbs  Blake,  under  whose 
care  she  was,  desired  my  assistance  in  the  case.  I  found  her  on  March  6th 
last  presenting  an  appearance  very  similar  in  many  respects  to  Case  XL V. 
described  a  few  pages  back.  The  tongue,  lips,  and  cheeks  were  fully  colored ; 
the  pulse  was  firm  and  rather  slow,  only  55  when  asleep.  The  temperature  of 

1  "  Gulstouian  Lectures,"  by  the  Author,  in  the  Lancet,  for  1850. 


INDIGESTION    OF    VARIOUS    FOODS.  71 

the  body  at  night  was  9G°  Fahr.  The  heart  and  lungs  were  perfectly  normal. 
The  urine  was  clear,  of  the  specific  gravity  from  l.Ol'i!  to  l.(iL'6.  The  bowels 
were  open  daily.  But  the  skin  was  harsh  and  dry,  the  emaciation  was  ex- 
treme; and  the  mamma*,  which  at  fifteen  and  sixteen  began  to  swell,  had 
completely  disappeared.  The  menses  had  not  again  shown,  though  the  pu- 
den<l;i  were  in  every  other  respect  developed  in  proportion  to  her  time  of  life. 

1  ordered  her  the  Pancreatic  Kinnlsion,  prepared  according  to  Dr.  Dobell's 
plan,  in  milk.  She  took  it  well  and  profited  remarkably,  so  that  when  I  sent 
for  her  to  come  again  to  London,  in  the  middle  of  April,  I  hesitated  at  first 
to  shake  hands,  supposing  it  to  have  been  a  sister  of  my  patient  that  I  saw. 
The  reason  for  bringing  her  up  to  London  again  was  however  this — she 
caught  a  catarrhal  cold,  it  flew  to  her  stomach,  the  emulsion  nauseated  her; 
and  yet  she  persisted  in  swallowing  it  with  her  innate  perseverance.  Suddenly 
while  engaged  in  playing  a  round  game  of  cards,  she  went  off  into  an  epileptic 
fit,  vomited  a  quantity  of  bile,  and  next  morning  knew  nothing  of  what  had 
taken  place. 

The  emulsion  had  done  its  work,  and  was  beginning  to  do  mischief.  It  has 
been  left  off,  and  I  have  heard  of  no  more  contre-temps. 

It  is  a  comfort  to  find  a  treatment  sometimes  during  harm,  it 
thereby  shows  itself  capable  of  doing  good. 

The  dryness  and  apparently  dead  dirty  aspect  of  the  skin  has 
been  noticed  in  several  of  the  last  cases  of  non-assimilation  of 
lat.  The  cutaneous  imperfection  sometimes  goes  farther  and 
t-xhibits  itself  in  the  shape  of  eruptions. 

CASE  XLVIII. — Miss  D'O — ,  aged  24,  has  never  been  plump  or  strong 
since  menstruation  was  first  established.  She  is  excessively  thin,  her  ribs 
sticking  out,  and  her  bust  flat,  enabling  the  normal  condition  of  the  lungs  and 
heart  to  be  easily  proved.  She  is  energetic,  pretty,  and  lively,  and  her  bright 
eyes  and  red  lips  are  much  admired.  The  specific  gravity  of  the  urine  is 
1.023,  and  it  deposits  lithates  on  cooling.  The  bowels  are  regular.  Rich 
food  is  disagreeable  to  her,  and  cream  indigestible,  so  that  she  is  accused  of 
being  fanciful  in  her  diet.  Latterly  she  has  suffered  great  inconvenience  from 
an  eruption  of  an  eczematous1  character  on  her  forehead  and  skin,  and  thinks 
she  is  thinner  and  thinner.  She  gets  on  well  enough  when  living  quite  quiet, 
but  animal  and  spiritual  life  enjoyed  for  a  season  throw  her  back  on  each 
occasion,  and  she  does  not  pick  up  her  health  again.  A  trip  to  Italy,  with 
its  numerous  temptations  to  bodily  and  mental  exertion,  was  the  last  blow. 
She  had  taken  tonics  and  homoeopathic  remedies. 

I  gave  her  the  Pancreatic  Emulsion,  which  is  working  apparent  benefit. 

1  Enema  =  "  a  superficial  formation,  consisting  mainly  of  serum  from  the 
denuded  connective  tissue  of  the  corium,  without  external  existing  causes."  I 
do  not  take  this  as  a  dogmatic  <lf tinition,  for  dfnuatoloifista  are  a  difficult  class 
to  please,  but  simply  to  explain  what  I  myself  mean  by  the  word. 


72  INDIGESTION    OF    VARIOUS    FOODS. 

In  a  lecture  on  Pulmonary  Consumption  in  18621  I  made 
some  observations  on  the  connection  between  that  disease  and 
cutaneous  degeneration,  apropos  of  a  case  of  impetigo  of  the 
finger-nails.  Perhaps  the  mal-assimilation  of  fat  has  something 
to  do  with  it. 

By  the  artificial  emulsion  of  fat  with  pancreatic  juice,  we 
certainly  seem  to  be  put  in  possession  of  an  easily  assimilated 
oleaginous  material,  and  a  most  valuable  contribution  to  the 
restorative  pharmacopoeia.  Dr.  Dobell  has  used  it  more  exten- 
sively than  anybody  else,  and  he  is  convinced  of  its  superiority 
to  Cod-liver  Oil  in  consumption.  My  only  fear  about  it  is  that 
careless  or  dishonest  chemists  might  manufacture  it  from  tri- 
chinous  swine,  should  it  chance  to  be  much  used;  and  then, 
being  unboiled,  it  would  be  a  possible  means  of  introduction  of 
that  dangerous  parasite.  Medical  men  should  warn  patients  to 
be  careful  whom  they  get  it  from. 

The  experiments  of  Drs.  Bidder  and  Schmidt,2  and  of  their 
pupil  Lenz,3  have  indeed  deposed  the  pancreas  from  the  position 
in  which  it  was  placed  by  Bernard1  as  almost  the  sole  actor  in 
the  digestion  of  fatty  substances ;  but  yet  it  still  remains  as  an 
important  link  in  the  chain  of  physiological  agencies  conducing 
to  that  digestion.  And  it  is  fortunately  one  which  we  are  able 
to  supply  by  artificial  means.  As  to  the  form  of  preparation  it 
is  much  more  practically  convenient  to  give  (as  is  done  in  the 
emulsion)  the  digester  and  the  article  to  be  digested  at  the  same 
time,  than  to  divide  them,  as  in  the  proposal  to  administer 
"Pancreatine"  prepared  after  the  fashion  of  Pepsine.  In  point 
of  fact,  it  is  probable  that  the  activity  of  the  Pancreatine  would 
be  entirely  obliterated  in  its  passage  through  the  stomach,  unless 
it  were  guarded  by  the  fat  with  which  it  is  already  united.  It 
is  the  fat  that  is  wanted,  and  this  is  an  easily  assimilated  form 
of  it. 

That  the  pancreas  is  an  important  agent  in  the  digestion 
of  fat  receives  powerful  support  from  a  class  of  fatal  cases  in 
which  the  whole  of  the  pancreas  is  organically  altered  in  struc- 

1  "  Lectures  chiefly  Clinical,"  p.  280  of  4th  edition. 

*  "Die  Verdauungssafte,"  pp.  241-259. 

'  Lenz,  "De  Adipis  Concoctione  et  Absorptione."     Dorpati,  1850. 

«  "Archives  Generates  de  Medecine,"  1849. 


INDIGESTION    OF    VARIOUS    FOODS.  73 

ture,  and  in  which  during  life  a  peculiar  inaptitude  to  digest 
adipose  tissue  has  been  observed.  I  shall  revert  to  this  subject 
in  illustrating  in  a  future  chapter  organic  changes  in  the  di- 
gestive viscera. 

SECTION  IV. 
Indigestion  of  Water. 

The  assimilation  of  water  is  the  least  vital  process  of  the 
whole  of  digestion.  It  would  seem  capable  of  entering  by  the 
simplest  endosmosis  from  the  alimentary  canal  to  the  blood- 
vessels, where  it  is  incorporated  with  the  blood  unchanged. 
The  process  can  be  carried  on  as  long  as  life  exists  at  all,  and 
in  obedience  to  the  mechanical  laws  of  diffusion. 

Now  the  chief  facts  observed  with  regard  to  the  connection 
of  membranes  with  liquids,  are  the  following : — 

1.  If  a  moist  membrane  be  interposed  between  aqueous  solu- 
tions of  different  densities,  two  currents  will  run  through  it,  one 
from  the  denser  to  the  rarer  liquid,  and  one  from  the  rarer  to 
the  denser,  and  the  latter  will  be  the  strongest  in  direct  propor- 
tion to  the  density. 

2.  The  current  is  increased  in  the  direction  of  a  liquid  in 
motion. 

3.  The  current  is  increased  in  the  direction  from  an  acid  to 
an  alkaline  fluid. 

4.  The  activity  of  osmosis  increases  with  the  temperature. 
There  are,  then,  in  the  circumstances  under  which  the  blood- 
Is  and  the  contents  of  the  bowels  are  placed,  three  very 

marked  principal  things  which  promote  the  passage  of  fluids 
into  the  former  from  the  latter  in  a  greater  degree  than  the 
reverse.  These  are : — 

1.  The  comparatively  greater  density  of  the  blood; 

2.  Its  motion ; 

3.  Its  alkalinity. 

At  the  same  time  the  animal  warmth  keeps  up  the  general 
activity  of  the  osmosis  in  both  directions  probably  in  the  ratio 
of  its  degree.  Where  any  of  these  conditions  are  diminished 
(removed  or  reversed  they  cannot  be  during  life),  then  the 
assimilation  of  water  is  retarded,  and  any  excess  remains  incon- 
veniently in  the  intestinal  canal  for  longer  than  usual. 


74  INDIGESTION    OF    VARIOUS    FOODS. 

CASE  XLIX. — A  somewhat  corpulent  lady  had  lost  much  blood  by  bleed- 
ing piles  before  she  applied  for  medical  advice,  so  that  she  was  reduced  to  a 
great  state  of  anaemia.  She  did  not  come  to  me  about  the  piles  (which  were 
removed),  but  on  account  of  the  flatulent  tumidity  of  the  intestines,  and  a 
perpetual  "  glug-glug"  in  them  when  she  moved  about.  Her  appetite  was 
bad,  and  she  therefore  washed  down  her  meals  with  copious  draughts  of 
water.  She  certainly  observed  that  the  more  liquid  she  took,  the  more  the 
"glug-glug"  was  distressing,  but  still  she  did  not  think  she  drank  more  than 
other  people.  I  told  her  she  must  drink  less  than  other  people,  and  to  that 
end  advised  the  use  at  meals  of  weak  lemonade  without  sugar  taken  in  sips, 
and  the  sucking  of  a  piece  of  liquorice  when  the  mouth  felt  dry  at  other  times. 

Here  the  thin  blood  of  anaemia  refused  to  absorb  as  quickly 
as  usual  the  watery  fluids  from  the  alimentary  canal,  exemplify- 
ing an  infringement  of  the  conditions  required  in  the  first  law  of 
osmosis. 

Corpulent  persons  are  generally  very  thirsty  souls.  In  two 
instances  (Cases  XXX  and  XXXI  of  my  Table  of  Cases  of 
Obese  persons,  "  On  Corpulence,"  page  142)  the  corpulence  was 
assigned  distinctly  to  this  cause.  But  they  are  inexplicably 
touchy  about  confessing  it.  I  cannot  make  out  why,  seeing  it 
is  diluted  drinks,  not  alcphol,  that  is  the  subject  of  inquiry.  I 
dare  say,  therefore,  that  the  patient  before  us  did  take  more 
fluid  than  other  people  in  spite  of  her  denial. 

The  "  glug-glug"  of  superabundant  water  may  be  distin- 
guished from  the  noises  of  flatulence  by  being  caused  only  by 
moving  the  body.  Gas  generally  is  loudest  when  the  patient 
is  still  after  exertion. 

CASK  L. — Mr.  H — ,  a  pork-butcher  of  healthy  appearance,  30  years  of  age, 
complained  to  me  of  the  weight  and  distension  which  he  always  felt  after  his 
usual  meals ;  though  if  he  took  a  chop  at  a  coffee-house  or  a  snack  standing 
he  did  not  feel  it.  The  difference  seemed  to  be  that  when  sitting  down  com- 
fortably at  his  leisure  he  took  a  considerable  allowance  of  liquid,  which  he  at 
other  times  avoided.  He  said  he  had  nothing  else  the  matter  with  him,  but 
observing  the  breath  short,  I  examined  the  heart,  and  found  a  loud  sawing 
systolic  murmur. 

Here  the  second  law  is  exemplified.  The  motion  of  the  blood 
was  retarded  by  the  valvular  disease  of  the  heart,  and  the 
absorption  of  fluids  in  the  oesophagus  and  stomach  proportion- 
ally retarded  likewise.  It  is  in  burly,  otherwise  healthy,  persons 
with  diseased  hearts  that  this  indigestion  of  water  is  most 


INDIGESTION    OF    VARIOUS    FOODS.  75 

generally  conspicuous.  "When  the  patients  are  seriously  ill  and 
laid  up  by  their  structural  ailment,  it  does  not  so  often  occur. 
Perhaps  they  are  not  so  thirsty,  and  so  do  not  put  the  matter  to 
the  t 

It  is  a  hint  sometimes  practically  valuable,  not  to  overburden 
with  slops  the  stomach  of  cardiac  invalids. 

Another  exemplification  of  the  secorvl  law  of  osmosis  may  be 
observed  in  impediments  to  the  motion  of  the  blood  from  the 

lungs: — 

1. 1. —Susan  B — ,  a  married  woman,  aged  41,  thin,  sallow,  and  hollow- 
eyed,  was  admitted  under  me  at  St.  Mary's,  June  l.">th.  1860.  She  had  been 
subject  to  shortness  of  breath  for  a  long  time;  but  this  symptom  had  been 
aggravated  since  the  previous  March,  when  she  seems  to  have  caught  cold. 
Since1  then  also  she  had  been  able  to  eat  her  food  only  very  dry,  for  if  she 
took  fluid  with  it.  nausea  and  vomiting  occurred.  This  was  worse  when  the 
asthma  was  worst.  The  kidneys  and  heart  were  healthy.  Her  appetite  was 
good. 

ll'iulaches  also  were  very  frequent,  but  they  seemed  independent  of  the 
gastric  ailments,  for  they  are  reported  when  these  latter  are  described  as 
better. 

The  usual  physical  signs  of  pulmonary  emphysema  were  present,  and  she 
was  treated  accordingly  with  Quinine.  Her  diet  was  meat  and  Pepsine.  She 
was  discharged  '-cured"  on  July  13th;  the  "cured"  referring  to  the  indiges- 
tion for  which  she  was  registered,  not  to  the  emphysema  I  presume. 

It  may  be  remarked  that  in  this  last  case  the  rejection  of  the 
T  by  the  digestive  organs  was  gastric,  whereas  in  the  two 
former  it  was  intestinal.  There  is  in  this  fact  no  significance 
of  the  locality  of  the  impediments  to  circulation — patients  with 
pulmonary  disease  quite  as  often  have  the  gurgling  on  move- 
ment, and  cardiac  patients  will  sometimes  vomit.  Indeed,  when 
you  are  thinking  of  them  only  as  mesttaijeries  of  the  blood,  the 
he;irt  and  lungs  are  one. 

An  illustration  of  the  third  law  of  osmosis  may  be  found  in 
almost  all  cases  of  dyspepsia. 

Let  the  reader  note  first  on  himself  what  takes  place  as  a 
consequence  of  food  in  the  normal  condition  of  the  stomach. 

him  take  the  specific  gravity  of  his  urine  on  rising  and 
look  at  the  color.  Then  let  the  stomach  be  thoroughly  roused 
to  acidity  by  a  healthy  breakfast  at  which  the  usual  quantity 


76  INDIGESTION    OF    VARIOUS    POODS. 

of  fluid  is  taken.  Observe  the  urine  passed  during  the  next 
two  hours.  It  is  paler,  of  lower  specific  gravity,  neutral,  per- 
haps alkaline.  The  fluid  contents  are  augmented  in  greater 
proportion  than  the  solid,  the  basic  elements  in  greater  propor- 
tion than  the  acid.  If  pickled  fish  and  light  white  wines  form 
part  of  the  breakfast,  the  limpidity  is  still  more  decided. 

The  explanation  of  this  I  believe  to  be  that  the  acid  of  the 
stomach  being  at  that  period  in  special  excess,  the  osmosis  of 
water  through  its  walls  into  the  alkaline  blood  is  peculiarly 
rapid.  Water  with  salts  and  solids  soluble  in  water  enter  into 
the  circulation  quickly,  and  fill  it.  They  pass  away  quickly  by 
the  kidneys,  carrying  off  often  some  of  the  blood's  soda  with 
them,  and  so  increasing  the  fixed  alkali  of  the  urine. 

When  the  stomach  gets  to  rest  again  and  is  neutral,  the  fluids 
do  not  pass  so  fast  into  the  blood,  or  away  by  the  renal  tubes ; 
then  the  urine  resumes  its  full  color,  acidity,  and  average 
specific  gravity. 

As  the  body  gets  tired  with  the  day's  work,  the  digestion  is 
not  so  active.  And  hence  after  luncheon  this  physiological 
variation  of  the  urine  is  not  so  marked,  and  still  less  after 
dinner. 

Now  observe  an  invalid,  the  vitality  of  whose  stomach  is 
below  par.  The  physiological  variations  are  much  less  marked, 
the  urine  is  never  so  high  and  rarely  so  low  as  that  of  a  healthy 
person  in  healthy  condition.  Its  acidity  also  alters  little  during 
the  twenty-four  hours.  The  interpretation  of  this  I  take  to  be 
the  imperfect  acidity  of  the  walls  of  the  stomach  causing  a  delay 
in  the  absorption  of  its  aqueous  contents,  which  lie  there  un- 
changed or  decomposing ;  in  either  case  a  burden,  giving  rise  to 
pain  and  inconvenience,  sometimes  to  vomiting. 

The  importance  of  obtaining  for  analysis  specimens  of  urine 
taken  at  various  periods  of  the  day,  instead  of  trusting  to  one,  is 
too  obvious  to  require  much  comment.  Take  for  an  example 
the  following,  which  the  date  allows  to  be  quoted  from  me- 
mory. 

CASE  LIT. — A  gentleman  came  to  me  yesterday  forenoon  about  a  defi- 
ciejicy  in  his  generative  powers  and  other  symptoms  unnecessary  to  detail. 
The  specific  gravity  of  some  urine  he  passed  was  1.015,  and  it  appeared  pro- 
bable that  it  was  upon  this  ground  that  the  medical  man  who  sent  him  to  me 


INDIGESTION    OF    VARIOUS    FOODS.  77 

had  been  giving  him  Iron.  I  told  him  to  come  again  this  morning,  and  bring 
a  specimen  made  on  rising,  as  well  as  another  specimen  of  that  after  break- 
fast. The  latter  was  again  about  1  015,  but  the  nocturnal  collection  was 
1  ."-i'..  showing  that  the  vitality  of  the  blood  and  assimilation  were  sufficient. 

SECTION  V. 
Treatment  of  Indigestion  Based  on  the  Article  of  Food  not  Digested. 

In  former  writings  on  this  subject1 1  attempted  a  division  of 
the  form  in  which  dyspepsia  is  manifested  according  to  the 
glands  whose  secretion  may  be  supposed  to  be  affected.  I 
thought  we  could  assign  some  to  the  oral  and  cesophageal,  some 
to  the  gastric  and  some  to  the  intestinal  portions  of  the  alimen- 
tary canal.  I  anticipated  that  we  might  find  a  "salivary" 
dyspepsia  of  starch,  a  "  gastric"  dyspepsia  of  albumen,  an 
u  intestinal"  dyspepsia  of  fat.  Further  experience  has  not 
confirmed  my  hopes  of  finding  any  such  trenchant  anatomical 
distinction  of  the  cases  which  came  before  us.  It  seems  to  me 
now  that  a  healthy  state  of  stomach  and  duodenum  is  as  essential 
healthy  state  of  mouth  to  the  digestion  of  amylaceous 
matters ;  that  the  salivary  and  intestinal  secretions  aid  power- 
fully the  digestion  of  albumen ;  and  that  even  fat  is  affected  by 
an  imperfect  activity  of  the  stomach.  I  have  therefore  in  this 
chapter  based  the  division  solely  upon  the  element  of  food  the 
ilip-stion  of  which  is  most  prominently  deficient.  It  must  be 
understood  that  "prominently"  does  not  mean  "solely;"  that 
where  one  article  of  diet  suffers,  the  other  suffers  with  it,  though 
perhaps  in  a  minor  and  masked  manner. 

This  prominence  of  the  indigestion  of  one  or  other  of  the  food 
elements,  to  what  should  it  lead  us  in  practice  ?  Some,  influ- 
rnr.-d  by  purely  cheiniral  considerations,  have  answered  off-hand 
that  ire  lia\  ••  only  got  to  omit  the  objectionable  article  from  the 
dietary  and  all  is  done.  That  which  causes  pain  is  to  be  left 
oil',  and  the  pain  ceases.  True,  but  man  is  an  omnivorous 
animal,  and  requires  omnigenous  food.  He  can  be  kept  alive 
perhaps  fora  time  on  one  food,  but  not  in  health.  Take  an  ex- 
ample of  the  carrying  out  of  such  a  treatment  a  /'«,// .Y"/*ee  in 
respect  of  vegetable  food : — 

1  "Digestion  and  its  Derangements." 


78  INDIGESTION    OF    VARIOUS    FOODS. 

CASE  LIU. — E.  H — ,  a  Liverpool  merchant,  aged  30.  of  muscular  build, 
but  rather  bloated  flabby  aspect,  came  to  me  in  December,  1859.  He  com- 
plained of  a  foul  taste  in  the  mouth  like  bad  fish,  low  spirits,  and  want  of 
appetite  for  breakfast.  He  had  also  occasional  attacks  of  headache  accom- 
panied by  nausea  and  vomiting,  which  nevertheless  did  not  relieve  his  per- 
manent condition.  He  had  been  gradually  getting  into  his  present  state  for 
six  years :  the  administration  of  bitters  and  acids  had  done  him  temporary 
good  occasionally,  but  worked  no  cure.  He  said  that  in  deference  to  medical 
advice  he  had  been  most  careful  in  his  diet,  eating  nothing  but  lean  meat  and 
stale  bread  or  biscuit.  Vegetables  had  been  forbidden,  because  they  had  at 
first  caused  flatulence  and  heartburn,  which  did  not  occur  at  all  under  the  use 
of  the  carnivorous  dietary.  On  examination  of  the  mouth,  the  tongue  was 
seen  to  be  coated  with  smooth  yellow  epithelium,  especially  at  the  sides ;  the 
gums  were  loosened  from  the  teeth,  swelled,  red-edged  and  soft.  The  patient 
said  they  often  bled  when  he  cleaned  his  teeth.  I  thought  at  first  some  of 
his  medical  advisers  must  have  given  him  Mercury,  but  I  could  get  no  history 
of  pills  or  powders,  in  which  that  metal  is  usually  administered,  and  I  am 
disposed  to  attribute  the  whole  of  his  existing  symptoms  to  an  exclusively 
meat  diet 

For  direct  treatment  I  advised  him  to  eat  milk  porridge  and  water-cresses 
for  breakfast,  salad  and  meat  and  stale  bread  for  luncheon  and  dinner,  and 
lemonade  or  fruit-water  ice  instead  of  tea.  As  an  indirect  aid  I  prescribed 
some  Bark  and  Chlorate  of  Potash.  He  soon  got  well. 

It  is  singular  how  slight  a  change  of  diet  will  bring  on  minor 
manifestations  of  scorbutus. 

CASE  LIV. — During  his  attendance  upon  me  after  a  severe  operation,  one 
of  the  leading  surgeons  in  Europe  related  a  bit  of  personal  experience  apro- 
pos of  my  complaining  of  gastralgia  after  salad  or  strawberries,  I  forget 
which.  He  said  he  took  a  house  out  of  London  one  summer,  and  used  after 
his  daily  work  to  join  his  family  (who  dined  early)  at  tea  and  mutton  chops. 
After  a  time  he  found  spots  of  purpura  on  his  legs,  boils,  etc.  He  exchanged 
the  tea  for  vegetables  and  beer,  and  immediately  regained  his  accustomed 
health. 

Patients  and  doctors  both  make  a  great  mistake  in  shunning 
absolutely  all  that  causes  pain  or  inconvenience.  They  ought 
to  consider  whether  the  thing  shunned  is  or  is  not  an  essential 
to  high  health :  if  it  be  so,  every  effort  should  first  be  used  to 
get  it  borne  without  pain ;  where  that  goal  cannot  be  reached, 
wisdom  and  duty  will  often  guide  us  to  submit  to  the  pain  for 
the  sake  of  the  accompanying  advantage. 

It  may  be  remarked  that  the  designed  attainment  of  any 
high  degree  of  voluntary  pleasure  always  involves  endurance — 


INDIGESTION    OP    VARIOUS    FOODS.  79 

eii'lurancc  of  disagreeable  sensations  which  coming  upon  us 
against  our  will  would  be  real  torture.  A  day's  hunting,  a 
h  at  cricket,  an  Alpine  tour,  even  a  picture-gallery  or  a 
ball,  success  in  love,  literature  or  war,  are  impossible  to  those 
who  recoil  from  bearing  immediate  pain.  This  ought  to  be — 
and  (experto  en  <!•••}  is — a  consolation  to  many  a  sensitive  sufferer. 
"\Vlien  it  is  pointed  out  that  their  pains  are  identical  with  what 
tlu-v  and  others  have  borne  without  a  murmur,  nay  without 
notice,  in  the  pursuit  of  enjoyment,  their  hopes  and  aims  may 
be,  not  so  much  for  the  absence  of  the  sensation,  as  for  the 
>r  which  will  ignore  it. 

The  avoidance  of  meat  on  account  of  the  inconvenience 
caused  by  it  may  bring  on  an  equally  undesirable  morbid  con- 
dition, though  not  so  distinctive  in  its  character  as  the  scorbutus 
exhibited  in  the  last  patient. 

:-:  LV. —  In  October,  1865,  a  maiden  lady  of  34  was  placed  under  my 
can-  Ky  Dr.  M'Call  Anderson,  of  Glasgow,  who  quite  agreed  with  me  in  my 
view  of  the  case,  though  circumstances  prevented  him  from  attending  to  her 

.f.  Since  girlhood  her  bowels  had  been  very  costive.  The  presence  of 
the  retained  feces  produced  disagreeable  sensations,  to  relieve  which  for 
twenty  years  she  had  been  in  the  habit  of  almost  daily  taking  purgatives  of 
her  own  accord.  For  the  last  few  years  pain  in  the  epigastrium  had  gradually 
become  habitual  with  her,  and  as  it  was  immediately  increased  by  taking  solid 

-he  had  entirely  ceased  to  take  meat.    The  consequence  was  inti 

'•ness,  increased  sensitiveness  of  epigastrium,  increased  debility.  The 
catamenia  diminished  in  quantity  and  frequency,  makiug  a  scanty  show  for  a 
day  <>r  two  about  three  times  a  year  during  the  height  of  summer,  and  never 
in  winter  at  all.  Her  complexion  was  pink  and  white,  and  her  lips  not  pale, 
but  she  was  very  thin. 

hud  an  opportunity  of  breaking  out  of  all  her  old  associations  and 
habits  by  u  visit  to  some  country  friends  in  France,  and  I  urged  her  to  accept 
it,  and  to  make  a  complete  change  in  her  mode  of  life.  I  desired  her  to  let 
her  bowels  go  unopened  for  as  long  as  four  days  if  they  chose,  and  then  use 
a  simple  water  enema,  if  necessary — to  bear  the  pain  cause.]  by  the  first  lew 
mouthl'uls  nf  each  meal,  and  to  eat  more  ami  more  meat  at  it  each  day  with- 
out flinching— to  drink  Burgundy.  To  aid  her  in  this  I  gave  her  for  a  few 
weeks  Quinine  and  Strychiiie  three  times  daily. 

The  last  report  I  have  of  her  is  dated  March  U.'id.  lM',0,  and  states  that  she 
required  no  cnemata.  the  bowels  acting  of  their  own  accord  every  three  days; 
that  food  scarcely  ever  causes  her  pain,  though  she  eats  nearly  as  much  as 
Other  people  ;  that  the  catatuenia  had  reappeared  in  the  I'ebruury  even  of  this 
backward  spring,  after  being  absent  since  the  previous  July. 


80  INDIGESTION    OF    VARIOUS    FOODS. 

I  said  just  now  that  as  much  injury  was  done  by  leaving  off 
meat  as  by  leaving  off  vegetables.  But  perhaps  I  ought  to  say 
greater,  for  though  it  is  not  so  prominent,  and  has  not  such  a 
distinctive  name,  the  condition  induced  by  it  is  longer  in  getting 
well,  and  might  just  as  easily  prove  fatal. 

Eemark  in  Case  LV  how  amenorrhoea  was  a  disease  of  the 
stomach ;  it  usually  is  so. 

The  habit  of  taking  purgatives  much  increases  abnormal  sen- 
sitiveness of  the  alimentary  canal,  especially  of  the  stomach.  To 
break  through  the  habit  is  essential  to  a  cure.  I  will  speak 
about  that  in  the  next  chapter. 

The  injudicious  omission  of  fat  from  the  dietary  must  doubt- 
less produce  similar  effects  to  those  which  follow  the  indigestion 
of  fat,  in  fact  the  converse  of  the  effects  which  we  aim  at  pro- 
ducing when  we  intentionally  administer  an  excess  of  it  as  a 
remedy.  As  under  the  use  of  an  easily  assimilated  oil  the  skin 
becomes  elastic  and  firm,  the  debilitating  fluxes  cease  from  the 
mucous  membranes  and  are  replaced  by  normal  secretions,  the 
nerves  feel  joyous  life  instead  of  perpetual  pain,  and  old  sores 
heal  up ;  so  we  may  expect  to  arise  from  a  deficiency  of  this 
article  of  food  a  dry  wrinkled  surface  to  the  body,  a  persistence 
of  leucorrhoeal  and  other  mucous  discharges,  that  feeling  of 
enduring  uneasiness  which  denotes  scant  life,  a  deterioration 
instead  of  a  renewal  of  all  the  tissues. 

But  I  am  not  able  to  find  any  good  illustrations  of  the 
matter.  Where  fat  has  been  omitted,  meat  seems  to  have  been 
omitted  also  in  most  of  the  instances  I  have  referred  to,  and  the 
symptoms  might  fairly  enough  be  attributed  in  a  great  measure 
to  that ;  or  else  there  has  been  a  complication  of  other  causes 
of  disease ;  or  else  the  omission  has  been  intentionally  remedial, 
designed  to  reduce  an  over-abundance  in  the  body. 

A  few  years  ago,  during  the  prevalence  of  the  attention  ex- 
cited by  Mr.  Banting's  case,  I  did  indeed  hear  reports  of  per- 
sons having  injured  themselves  by  adopting  with  over- strictness 
the  system  by  which  that  famous  man  tells  us  he  regained  the 
sight  of  his  toes,  forgetting  that  no  similar  mountain  to  his 
had  ever  impeded  their  view.  But  I  never  saw  a  real  case  in 
point.  If  the  experimenters  are  really  over-corpulent,  they  feed 


INDIGESTION    OF    VARIOUS    FOODS.  81 

on  their  own  fat,  and  submit  with  ease  and  advantage  to  the 
discipline;  if  they  are  not  so,  the  instinctive  desire  becomes  so 
strong  that  they  cannot  resist  the  sight  of  the  forbidden  luxury 
on  the  table.  The  possible  rectification  of  their  circumference 
is  not  worth  such  stoicism,  and  they  stop  in  good  time. 

I  do  not  think,  then,  that  we  profit  much  from  those  off-hand 
advisers  who  suppose  they  accomplish  everything  by  forbidding 
the  use  of  the  sort  of  food  which  produces  the  symptoms. 
Neither  in  the  indigestion  of  vegetable,  animal,  oleaginous,  or 
ry  articles  of  diet  does  this  restore  health.  On  the  con- 
trary, as  I  have  shown  by  examples  which  every  one  may  cap 
out  of  his  own  patients,  if  he  will  but  turn  them  over  in  his 
mind,  an  actual  state  of  disease  may  arise  from  persistence  in 
the  remedy. 

A  short  repose  for  a  time,  and  abstinence  from  an  unnecessary 
excess  in  the  undigested  dishes,  is  doubtless  wise.  But  that 
abstinence  must  not  be  complete  or  final.  What  the  patient 
wants,  when  he  complains  he  cannot  eat  so-and-so,  is  not  to 
have  "  don't"  said  to  him — his  stomach  has  said  so  already — 
but  to  be  enabled  to  eat  it  like  other  people. 

The  temporary  repose  may  be  accomplished  often  by  a  change 
in  the  mode  of  preparation  of  the  articles  which  cause  most  in- 
convenience, often  by  the  substitution  of  something  else,  not  so 
agreeable  perhaps  or  so  common,  but  which  will  not  be  objected 
to  for  a  time. 

The  following  details  may  furnish  examples  and  limits. 

IN*  STARCH  OR  SUGAR  INDIGESTION. 

The  use  of  sugar  in  such  quantity  as  to  cause  a  sweet  taste 
may  be  left  off.  Tea  may  be  taken  in  the  Russian  fashion, 
ing  the  hot  tea  on  a  slice  of  lemon  with  the  skin  on,  thus 
retaining  all  the  aromatic  stimulus  of  the  drink  without  its 
indigegtibility.  And  all  lo/en^es  and  sn^ar-j'lnms  and  sweet 
confectionery  will  be  interdicted.  The  best  substitute  is  or;i 
or  lemons. 

For   ordinary   bread  may   be   substituted   biscuit,   toast,  or 
Stevens'  unrated   l>rea«l.      Ixiker's  bread    is  usually  easier   of 
digestion  than  home-made. 
6 


82  INDIGESTION    OF    VAEIOUS    FOODS. 

Potatoes  may  be  finely  mashed  and  mixed  with  meat  gravy. 

As  vegetables,  stewed  lettuces,  cabbages,  spinach  (hot),  and 
golden  cress,  water-cress,  and  salad  (cold),  may  be  taken.  A 
small  quantity  only  of  these  is  required  to  keep  up  the  health, 
and  nobody  eats  so  much  of  them  as  they  do  of  potatoes. 

From  green  vegetables  possible  of  digestion  by  weak  stomachs 
must  be  carefully  excepted  peas,  beans,  and,  in  short,  all  the 
papilionaceous  plants  usually  eaten  green.  They  are  famous 
for  producing  flatulence.  M.  Chomel  attributes  this  to  the 
evolution  of  atmospheric  air  contained  in  their  spongy  husks ; 
but  I  think  the  cause  lies  deeper  than  that — perhaps  in  the 
specific  action  of  their  empyreuma,  arresting  the  absorption  of 
air  in  weakly  persons.  *  Else  why  do  they  not  produce  equal 
effects  in  the  healthy  ? 

An  example  of  the  mechanical  differences  made  by  cookery 
in  the  form  of  starchy  food,  are  the  two  sorts  of  crust  known  as 
"short"  and  "puff"  paste.  In  the  former,  the  butter  is 
thoroughly  incorporated  with  the  dough,  so  as  to  divide  the 
starch-granules  one  from  another,  and  permeate  the  gluten ; 
while  in  the  latter  the  dough  forms  thin  layers,  like  a  quire  of 
buttered  paper.  If  the  teeth  are  imperfect  or  mastication  care- 
less, those  'strata  of  dough  are  well  known  to  form  in  the 
stomach  a  solid  mass,  which  is  difficult  of  solution  in  the  upper 
part  of  the  intestines  ;  whilst  the  friable  paste  (the  "  short")  is 
mixed  with  the  rest  of  the  food,  and  if  the  butter  be  fresh, 
causes  no  discomfort. 

!Now,  some  dyspeptics  are  such  delicate  measures  of  good  or 
bad  cookery,  that  they  can  take  "  short"  pastry,  but  not 
"  puff."  It  is  always  worth  while  to  make  the  trial. 

There  is  an  advantage  in  not  mixing  too  much  the  animal 
and  vegetable  food.  In  a  weak  stomach  they  interfere  with 
one  another's  digestion.  A  light  luncheon  of  bread  and  butter, 
rice  pudding,  fruit,  and  vegetables  with  a  little  vinegar,  can 
often  be  borne  without  inconvenience,  which  with  the  addition 
of  meat  would  have  caused  flatulence.  The  dinner  after  this 
may  be  restricted  to  meat  without  injury. 

Particular  care  should  be  taken  that  vegetables  are  thoroughly 
boiled  soft  all  the  way  through,  and  dried  on  a  cullender. 

A  certain  quantity  of  oleaginous  matter  renders  vegetables 


INDIGESTION    OF    VARIOUS    FOODS.  83 

in  which  there  is  much  combined  water,  less  massive  in  the 
stomach.  Thus,  milky  rice  pudding  does  not  collect  into  a 
lump  as  plain  rice  is  apt  to  do.  In  making  the  latter  dish  up 
fur  baking,  eggs  should  never  be  used.  Baked  albumen  is  one 
of  the  most  insoluble  forms  of  albumen. 

Plain  1it.il.-il  rice  should  always  have  a  little  fresh  cold  butter 
mixed  up  \vith  it.  In  that  way  it  makes  an  accompaniment  of 
•  at  dim 

Stewed  pears  ami  roast  apples  are  a  good  substitute  for  sweets. 
itle  butter  improves  them  also. 

But  melted  butter  sauce  is  an  abomination.  Nine  times 
out  of  ten  it  is  rancid,  or  becomes  so  five  minutes  after  it  is 
swallowed, — that  is  to  say,  directly  the  flour  in  it  is  converted 
bv  the  saliva  into  glucose.  The  best  sauces  are  pepper  and 
vinegar. 

IN  CNDIG  KSTION  OF  ANIMAL  FOOD,  it  will  be  found  to  be  gene- 
rally the  form  rather  than  the  chemical  constitution  of  the 
aliment  against  which  the  stomach  rebels. 

c 

Observe  the  preparation  of  food  as  arranged  by  nature  for  the 
delicate  stomachs  of  the  new-born.  It  is  completely  fluid;  the 
various  elements  are  intimately  mixed  together,  and  are  further 
aided  in  their  solution  by  the  lactic  acid  into  which  it  decom- 
poses. Milk  is  not  only  a  type,  but  is  also  itself  the  most 
•ood  for  extreme  weakness.  I  have  never  yet  met 
with  a  stomach  which  could  not  bear  it  either  made  into  whey, 
or  prevented  from  coagulating  by  the  admixture  of  lime-water. 
This  fluid  meat  will  pass  through  the  stomach  unaltered,  the 
:  ic  juice  will  trickle  through  the  pylorus  at  its  leisure  after 
it.  and  with  the  intestinal  juice  will  digest  the  casein  in  the 
intestii, 

I  do  not  think  any  one  could  deserve  better  of  his  country 
than  by  the  establishment  of  a  farm  where  the  milk  treatment 
could  he  systematically  carried  out,  as  at  Ga'is  and  elsewhere  in 
Switzerland. 

The  chief  aid  olYen-d  by  art  to  the  conversion  of  albuminoids 
into  the  state  of  peptone  is  to  increase  their  softness  and  per- 
meability by  water,  so  that  the  converting  juice  may  h;; 
to  every  particle  as  soon  as  possible.    The  mechanical  condition 
of  the  nitrogenous  aliments  is  of  tenfold  more  importance  than 


84  INDIGESTION    OF    VARIOUS    FOODS. 

the  quantity  of  nitrogen  they  contain.  If  enveloped  in  an 
insoluble  layer  of  their  own  or  other  substance,  they  are  in  fact 
as  useless  as  gold  locked  up  in  a  box. 

Next  to  milk,  the  most  digestible  form  of  animal  food  is  pro- 
perly made  beef-tea.  The  following  is  the  best  receipt  for 
dietetic  purposes. 

Recipe  for  malting  Beef-tea  nutritious. 

Let  the  cook  understand  that  the  virtue  of  beef-tea  is  to  contain  all  the 
contents  and  flavors  of  lean  beef  in  a  dilute  form ;  and  its  vices  are  to  be 
sticky  and  strong,  and  to  set  in  too  hard  a  jelly  when  cold. 

When  she  understands  this,  let  her  take  half  a  pound  of  fresh-killed  beef 
for  every  pint  of  tea  she  wants,  and  carefully  remove  all  fat,  sinew,  veins,  and 
bone.  Let  it  be  cut  up  into  pieces  under  an  inch  square,  and  set  to  soak  for 
twelve  hours  in  one  third  of  the  water  required  to  be  made  into  tea.  Then 
let  it  be  taken  out,  and  simmered  for  three  hours  in  the  remaining  two  thirds 
of  the  water,  the  quantity  lost  by  evaporation  being  replaced  from  time  to 
time.  The  boiling  liquor  is  then  to  be  poured  on  the  cold  liquor  in  which  the 
meat  was  soaked.  The  solid  meat  is  to  be  dried,  pounded  in  a  mortar,  and 
minced  so  as  to  cut  up  all  strings  in  it,  and  mixed  with  the  liquid. 

When  the  beef-tea  is  made  daily,  it  is  convenient  to  use  one  day's  boiled 
meat  for  the  next  day's  tea,  as  thus  it  has  time  to  dry  and  is  easiest  pounded. 

Some  persons  find  it  more  palatable  for  a  clove  of  garlic  being  rubbed  on 
the  spoon  with  which  the  whole  is  stirred. 

The  utility  of  decoctions  of  animal  food  depends  on  several 
circumstances  which  modify  the  advantages  accruing  from  their 
liquid  state.  Heat  seems  to  have  an  effect  in  some  degree  pro- 
portioned to  the  period  of  application,  rendering  albumen  more 
or  less  insoluble,  at  the  same  time  that  to  a  delicate  palate  there 
is  a  decided  loss  of  savor.  Thus  soups  and  stews  which  are 
"  kept  hot"  are  wholesome  enough  during  the  first  few  hours, 
may  be  digested  at  a  railway  refreshment  room  for  some  hours 
after,  but  on  the  second  or  third  day  give  the  rash  stranger 
beguiled  into  a  Palais  Eoyal  two-franc  dinner  an  infallible 
diarrhoea.  (Probatum  est.)  Though  finely  divided,  the  minute 
fragments  of  muscular  fibre  seem  to  be  individually  rendered 
insoluble  by  continued  heat.  Good  soup  is  that  which  is  made 
most  like  the  above-described  beef-tea,  and  is  a  highly  digestible 
article ;  bad  soup,  that  which  least  resembles  it,  and  is  to  be 
avoided  as  poison.  Next  to  good  soup  in  digestibility  comes 
sweetbread. 


INDIGESTION    OF    VARIOUS    FOODS.  85 

At  a  very  early  stage  of  the  treatment  of  albuminous  indiges- 
tion, tender  roast  leg  of  mutton  can  be  borne.  A  chemical  view 
of  the  process  of  roasting  shows  it  to  fulfil  all  the  indications  of 
perfect  cookery.  The  heat  radiated  from  the  open  range  coagu- 
the  outer  layer  of  albumen,  and  thus  the  exit  of  that  still 
fluid  is  prevented,  and  it  becomes  solidified  very  slowly,  if  at  all. 
The  areolar  tissue  which  unites  the  muscular  fibres  is  converted 
by  gradual  heat  into  gelatine,1  and  is  retained  in  the  centre  of 
the  mass  in  a  form  ready  for  solution.  At  the  same  time,  the 
fibrine  and  albumen  take  on,  according  to  Dr.  Mulder,8  a  form 
more  highly  oxidized,  and,  especially  in  the  case  of  the  former, 
more  capable  of  solution  in  water.  The  fat  also  is  melted  out  of 
the  fat-cells,  and  is  partially  combined  with  the  alkali  from  the 
serum  of  the  blood.  Thus  the  external  layer  of  albumen  becomes 
a  sort  of  case,  which  keeps  together  the  important  parts  of  the 
dish  till  they  have  undergone  the  desirable  modification  by  slow 
heat — a  case,  however,  permeable  in  some  degree  by  the  oxygen 
of  the  free  surrounding  air,  so  that  most  of  the  empyreumatio 
oils  and  products  of  dry  distillation  are  carried  off.  This  is  no 
loss  either  to  our  stomachs  or  our  palates.  If  acetic  acid  be 
generated  it  is  probably  carried  off,  and  if  not  carried  off  it  is 
neutralized  by  the  alkaline  carbonates,  as  certainly  roast  meat  is 
not  acid  to  test-paper  if  quite  fresh.  The  little  that  may  remain 
probably  renders  the  muscular  fibre  more  soluble. 

Roasting,  therefore,  is  as  scientific  and  wholesome,  and  there- 
fore as  economical  a  process  as  it  is  a  palatable  one,  and.  is  well 
worth  the  extra  expenditure  of  fuel  which  is  entailed.  Baking 
can  never  take  its  place,  especially  for  invalids ;  for  it  concen- 
s  in  the  meat  all  the  empyreumatic  products  of  slow  com- 
bustion. 

Rapid  boiling  may  effect  in  some  minor  degree  the  case- 
hardening  of  the  meat  above  described,  but  the  interior  albumen 
seems  after  this  process  also  more  solid  and  less  digestible. 

Slow  boiling  at  a  low  temperature  makes,  it  is  true,  a  nourish- 
ing soup,  but  converts  th$  muscular  fibre  into  a  mass  of  hard 

1  Not,  however,  the  sarcolemma,  which  an  experiment  of  Professor  Kiilliker's 
seems  to  remove  from  the  class  of  substances  yielding  gelatine.  See  Kulliker'a 
"  Mikros.  Anat.,"  vol.  ii.  \>. 

*  QuoU'.l  in  Muleschott's  "  Diiitetik,"  p.  450. 


86  INDIGESTION    OF    VARIOUS    FOODS. 

strings,  which,  eaten  or  not  eaten,  are  in  nine  cases  out  of  ten 
equally  wasted.  The  relics  to  be  found  in  the  feces  exhibit  all 
the  transverse  strise  of  their  original  state,  quite  unaffected  by 
their  intestinal  journey.  The  ojily  way  to  make  bouillon 
digestible  is  to  beat  it  up  in  a  mortar  to  a  fine  pulp  and 
mix  it  with  the  soup,  as  prescribed  above  in  the  recipe  for 
beaf-tea. 

Of  all  meats,  mutton  is  the  most  digestible,  because  it  is, 
when  roast,  the  closest  grained,  most  friable,  and  least  infiltrated 
with  fat. 

Birds,  on  the  other  hand,  when  roasted,  still  more  when 
baked,  are  apt  to  be  too  much  dried  up.  And,  therefore,  if  you 
cannot  trust  thoroughly  the  goodness  of  your  patient's  cook, 
he  had  better  have  his  fowls  and  his  partridges  boiled.  Other 
birds  are  either  too  dry,  too  oily,  or  too  empyreumatic  for 
invalids. 

I  have  sometimes  found  toasted  cheese  borne  by  a  stomach 
to  which  meat  gave  pain.  The  cheese  must  be  quite  new,  and 
toasted  very  soft.  In  this  form  it  is  both  digestible  and  palatable. 

The  quantity  of  albuminous  food  should  be  gradually  in- 
creased from  day  to  day ;  but  the  invalid's  plate  should  never 
be  overloaded.  The  look  of  more  than  he  can  eat  sets  him 
against  it.  Judicious  times  for  pressing  food  should  be  selected. 
A  cup  of  beef-tea  on  going  to  sleep  can  often  be  borne,  when 
ordinary  meals  excite  nausea. 

Ladder  of  meat-diet  for  invalids. 

Whey.  Turtle  soup. 

Milk  and  lime-water.  Sweetbread  or  Tripe. 

Milk  and  water.  Boiled  partridge. 

Plain  milk.  Boiled  chicken. 

Milky  rice-pudding.  Boiled  lamb's  head  and  brains. 

Beef-tea.         •  Mutton  chop. 

Plain  mutton  broth.  Eoast  joint  of  mutton. 

Scotch  broth. 


In  cases  where  there  is  a  repugnance  to  fat,  light  friable  fish, 
such  as  boiled  sole,  or  turtle  fins,  or  water  soojee,  will  be  toler- 


INDIGESTION    OF    VARIOUS    FOODS.  87 

at.-d,  while  red  meat  excites  disgust.  It  is  not  nearly  so  soluble 
in  gastric  juice,  nor  so  nutritious,  but  it  makes  a  variety. 

Oysters  are  best  eaten  raw,  in  which  state  they  carry  with 
them  their  own  pepsine  for  their  digestion.  Cooking  toughens 
them. 

The  u.se  of  Pepsine,  or  artificial  gastric  juice,  as  a  remedy,  is 
•ially  indicated  in  the  indigestion  of  flesh  food.  But  I 
think  that  since  its  introduction  to  general  use  through  the 
11  ions  preparation  of  Dr.  Corvisart,  it  has  caused  more  dis- 
appointment than  satisfaction.  This  is  because  it  has  been 
•jiven  in  unsuitable  cases,  and  because  impossible  expectations 
have  been  founded  upon  it. 

The  cases  in  which  it  is  really  useful  are  those  where  a  pro- 
-ive  aiuemia  is  accompained  by  an  inability  to  digest  albu- 
minous food.  This  inability  is  exhibited  in  three  ways:  first, 
by  meals  of  such  diet,  even  in  very  small  quantities,  being  fol- 
lowed by  a  sense  of  great  weight  and  oppression  at  the  epigas- 
trium, and  sometimes  by  actual  vomiting;  secondly,  by  the 
tge  of  loose  fetid  stools  containing  much  unaltered  muscu- 
lar fibre,  lumps  of  fat,  and  such  like  remnants  of  a  recent  meal ; 
thirdly,  by  loss  of  appetite  and  a  nausea  roused  by  the  bare 
of  fle.-h  food.  Often  all  three  phenomena  exist  together; 
but  each  one  may  be  found  separately,  and  is  of  itself  a  suffi- 
cient indication  of  the  patient's  state. 

The  state  of  the  stomach  when  these  symptoms  occur  is  often 
an  excessive  secretion  in  the  upper  part  of  the  alimentary  canal 
of  alkaline  mucus,  which  envelops  the  food,  and  prevents  the 
action  of  the  gastric  juice  upon  it.  The  consequence  is,  either 
its  rapid  ejection  unaltered,  or  its  decomposition,  and  the  evo- 
lution of  fetid  gas.  If  vegetable  food  be  mixed  with  the  meat, 
it  ferments  into  acetic  arid  ;  and  thus  you  may  have  sour  eruc- 
tations from  the  stomach,  and  diarrhoea.  If  this  excessive  secre- 
tion of  mucus  is  recent  and  moderate,  the  appetite  may  remain 
uninjured — nay,  may  sometimes  In-  morbidly  increased;  but  a 
long  continuance.  My  if  joined  to  progressive  pulmonary 

is  sure  to  induce  an  an;emic  condition  of  the  alimentary 
••anal,  which  results  in  a  disgust  for  food. 

This  state  of  tliiir_r>  it  is  very  important  to  check.  If  it  goes 
on,  the  patient  cannot  take  in  sufficient  quantities  the  meat 


88  INDIGESTION    OF    VARIOUS    FOODS. 

which  should  refresh  his  degenerating  muscles  and  pale  blood ; 
he  cannot,  if  phthisical,  take  the  Cod-liver  oil  which  is  to  replace 
his  emaciating  tissues;  he  cannot,  from  weakness,  take  the  ex- 
ercise which  might  renew  his  whole  diseased  system.  And  I 
do  not  know  any  remedy  which  more  readily,  obviously,  and 
directly  does  what  it  can  towards  checking  such  a  state  than 
Pepsine.  It  acts  immediately  and  surely. 

We  must  not,  however,  raise  our  expectations  of  the  power 
of  Pepsine  too  high,  or  we  shall  be  disappointed.  I  said  just 
now  it  "  does  what  it  can,"  and  I  would  have  understood 
clearly  what  position  this  agent  holds  in  the  rational  materia 
medica,  and  then  we  shall  know  what  good  results  may  be  de- 
manded with  reasonable  hopes  of  obtaining  them.  It  is  an 
artificial,  and  therefore  a  partial,  substitute  for  a  natural  process. 
Gastric  juice  from  a  healthy  animal  is  mixed  with  the  food,  in- 
stead of  that  which  the  patient's  stomach  ought  to  prepare. 
And  it  acts  in  the  body  just  as  it  would  out  of  the  body  under 
the  same  circumstances  of  heat  and  motion.  The  chewed  meat 
is  dissolved  by  it  just  as  white  of  egg  suspended  in  a  beaker  is 
dissolved  by  it ;  and  the  putrefactive  process  is  arrested  by  it 
in  the  intestinal  canal  just  as  the  putrefactive  process  is  arrested 
by  it  in  the  laboratory. 

For  you  may  observe  that  albumen  suspended  for  twelve 
hours  in  Pepsine  is  quite  sweet,  whereas  that  soaked  for  the 
same  time  in  saliva  is  most  fetid.  It  is,  therefore,  a  substitute 
for  the  natural  secretion,  and  to  a  certain  extent  supplies  its 
place. 

But  like  all  imitations  of  nature  it  is  coarse  and  imperfect. 
The  solvent,  instead  of  being  gradually  and  continuously 
poured  "on  the  outside  of  the  mass  of  food,  is  mixed  up  in  the 
middle  part  of  it,  and  acts  merely  chemically,  without  any  of 
the  mechanical  and  physiological  helps  belonging  to  natural 
digestion,  and  consequently  soon  exhausts  its  energies.  The 
chyme,  or  albumen  prepared  for  absorption,  instead  of  being 
wiped  off  and  swept  away  by  the  stomach,  remains  for  some 
time  mixed  up  with  the  Pepsine,  so  that  the  latter  is  not  freed 
for  the  solution  of  a  new  portion.  By  this  imperfect  process 
only  a  very  small  portion  of  meat  can  be  dissolved.  The  small 
quantity  of  Pepsine  in  the  powder  is  ridiculously  inadequate  to 
the  wants  of  a  healthy  stomach. 


INDIGESTION    OP    VARIOUS    FOODS.  89 

If  therefore  a  patient  hopes  that  by  the  aid  of  Pepsine  he 
can  get  a  full  and  sufficient  meal  digested  at  once,  he  will  fail. 
But  let  him  take  about  half  a  mutton  chop  with  the  remedy 
the  first  day ;  and  if  that  is  digested  well,  next  day  a  whole 
chop ;  but  then  he  has  got  to  the  end  of  his  tether,  and  the 
digestion  of  a  larger  quantity  will  not  be  at  all  assisted  by  arti- 
ficial solvents.  After  a  chop  has  been  digested  and  absorbed 
twice,  or  even  once,  a  day  by  this  means  for  about  a  week  or  ten 
days,  the  expedient  has  probably  done  all  the  work  that  can  be 
fairly  asked  of  it,  and  the  stomach  has  either  recovered  suffi- 
cient to  digest  alone,  or  will  require  different  remedies  to  enable 
it  to  do  so. 

Therefore,  for  the  Pepsine  to  be  completely  successful — first, 
it  must  be  given  only  to  those  who  cannot  digest  half  a  mutton- 
chop  without  it ;  secondly,  more  than  a  chop  must  not  be  given 
at  once;  thirdly,  it  must  not  be  required  to  go  on  alone  improv- 
ing the  patient's  condition  for  more  than  a  week  or  ten  days. 

But  for  the  time  named  I  advise  its  being  given  alone,  and 
the  action  not  interfered  with  in  general  by  other  medicines. 
Many  will  really  prevent  its  chemical  effect,  and  all  will  confuse 
your  judgment  of  the  advantage  gained.  In  this  time  it  will 
generally  be  found  that  the  repugnance  of  the  patient  to  meat 
has  been  overcome,  and  that  a  small  quantity  of  it  at  a  time 
can  be  relished  and  digested ;  the  morbid  fetor  of  the  stools 
diminishes,  and  the  flatulence  and  distress  arising  during  their 
passage,  through  the  bowels  ceases.  A  renewed  strength  and  a 
renewed  power  of  assimilation  commences,  the  sleep  becomes 
more  natural,  with  the  diminution  of  night-sweats  and  hectic ; 
while,  at  the  same  time,  the  pulmonary  symptoms  of  cough, 
dyspno3a,  &c.,  relax,  and  a  step  at  any  rate  is  taken  in  the  right 
direction  towanls  the  cure  of  the  disease.  It  is  remarkable, 
too,  what  a  slight  improvement  in  the  digestive  powers  will 
often  enable  the  patient  to  take  Iron  and  Cod-liver  oil.  These 
are  acknowledged  the  mainstays  in  the  treatment  of  tubercular 
consumption,  ami  any  expedient,  however  temporary,  which 
will  pave  the  way  for  their  administration,  is  a  great  boon. 

Iv  TIIK  ixniGF.sTiox  OF  FAT  a  purpose  si  milar  to  that  assign. '>! 
to  Pepsine  in  the  last  paragraphs  is  performed  by  Panereatine. 


90  INDIGESTION"    OF    VARIOUS    FOODS. 

In  a  classification  of  curative  agents  I  have  put  the  two  together 
as  "Constructive"  or  "Histotrophic"  remedies.1  But  in  the  form 
of  pancreatic  emulsion,  as  devised  by  Dr.  Dobell,  the  solvent 
and  substance  to  be  dissolved  are  united  together,  and  their 
mutual  reaction  has  already  partly  taken  place.  I  have  already 
spoken  of  the  necessity  for  and  advantages  of  this  union.  It  is 
better  than  Cod-liver  oil,  because  it  carries  the  agent  of  its  own 
solution  along  with  it. 

THE  INDIGESTION  OF  WATER  as  a  consequence  of  anasmia  is 
cured  by  the  administration  of  Iron.  Where  it  results  from 
heart  disease  or  emphysema,  it  indicates  a  mercurial  purgative, 
and  is  temporarily  relieved  by  its  emptying  the  congested  portal 
circulation.  An  observant  patient  of  mine  with  emphysema 
tells  me  that  she  finds  it  a  good  rule  never  to  drink  with  her 
meals. 

SECTION   VI. 
Treatment  based  on  pathological  condition. 

It  cannot  but  strike  any  one  who  reviews  either  the  typical 
cases  I  have  collated  from  my  notes,  or  those  (not  essentially 
different,  I  am  sure)  which  have  occurred  in  his  own  practice, 
that  a  general  deficiency  of  the  vital  powers  is  more  notably 
exhibited  in  indigestion  than  in  any  other  disease.  And  this 
is  equally  apparent  in  each  form  of  indigestion  from  whatever 
cause  arising.  I  always,  therefore,  look  forward  to  giving 
tonics  as  the  prime  therapeutical  aim  in  all  cases.  Sometimes 
that  part  of  the  treatment  can  be  commenced  forthwith,  some- 
times it  will  be  necessary  to  relieve  temporarily  certain  of  the 
prominent  symptoms  first,  but  without  tonics  no  cure  is  effected. 

My  favorite  tonic  is  Quinine,  in  two-grain  doses  in  lemon- 
juice  sufficient  to  dissolve  it,  and  diluted  with  water  to  a  con- 
venient bulk.  Its  action  seems  to  be  principally  on  the  mucous 
membrane  of  the  mouth,  oesophagus,  and  stomach,  which  it 
astringes  and  tones  up  to  a  healthy  state,  restraining  the  secre- 
tion of  mucus,  and  making  the  special  secretions  more  active. 

To  Quinine  I  usually  add  from  2\th  to  ^gth  of  a  grain  of 
Hydrochlorate  of  Strychnia,  unless  there  are  some  contra-indi- 

1  "  Lectures,  chiefly  Clinical,"  2d  Introductory  Lecture  in  4th  edition. 


IXDIGESTIOX    OF    VARIOUS    FOODS.  91 

cations  to  its  use.  It  relieves  flatulence,  and  that  feeling  of 
sinking  when  the  stomach  is  empty,  which  arises  from  a  slug- 
gish state  of  the  involuntary  muscular  fibres ;  and  in  cases  of 
constipation  reinforces  the  expulsive  action  of  the  peristaltic 
fibres  on  the  mass  of  feces.  The  principal  contra-indication 

s  use  is  an  over-sensitive  state  of  the  nervous  system.     I 
been  obliged  to  leave  it  off  in  several  cases  of  hysterical 

en  because  of  the  neuralgia  which  followed  it,  and  in  two 

uces  of  men  agitated  by  business  I  have  had  want  of  sleep 
and  excitement  of  mind  attributed  with  apparent  justice  to 

•liuine.  In  the  doses  quoted  cramps  never  are  produced, 
and  the  slight  inconveniences  I  have  named  cease  immediately 
the  alkaloid  is  omitted. 

In  large  quantities  Strychnine  may  sometimes  produce 
spasmodic  action  of  the  muscles.  I  have  had  this  happen  in 
hospital,  when  administering  it  for  other  complaints.  But  even 
then  not  the  slightest  harm  accrues,  if  the  amount  is  diminished. 
Some  persons  have  a  fear  of  its  accumulating  in  the  body,  and 
the  effect  of  successive  doses  being  concentrated  into  one,  which 
to  me  seems  impossible  in  a  soluble  diffusible  salt.  The  fallacy 

urobably  arisen  thus — in  cases  of  paralysis,  for  which 
hnia  was  originally  prescribed,  the  nervous  system  is 
usually  so  prostrate  as  not  to  respond  to  even  considerable 
quantities:  utter  a  time  the  patient  becomes  more  healthy  and 
more  sensitive,  and  then  the  dose  which  had  been  given  day 
after  day  without  effect,  acts  perceptibly,  and  perhaps  vigorously 
— acting  thus,  not  because  it  has  accumulated,  but  because  the 
nerves  have  at  last  become  well  enough  to  be  conscious  of  it. 
A  soluble  and  diluted  salt  of  Strychnia  seems  to  me  one  of  the 
most  manageable  drugs  we  have  in  the  Pharmacopoeia,  because 
you  can  graduate  the  dose  accurately  to  your  requirements. 
The  extract  of  Nux  Voniica  is  dangerous,  because  you  never 
know  the  exact  strength  of  the  preparation  sold. 

This  treatment  of  indigestion  does  not  interfere  with  remedies 
addressed  to  check  pain,  pyrosis,  vomiting,  or  any  of  the  other 
morbid  phenomena,  which  will  be  discussed  in  future  chapters. 
Neither  does  it  interfere  with  the  use  of  Iodide  of  Potassium  as 
a  temporary  augmentation  of  the  salivary  secretion.  I  ; 
found  it  the  most  universally  applicable,  and  therefore  I  do  not 
mention  others  of  less  value. 


92 


CHAPTEE   III. 
HABITS  OF  SOCIAL  LIFE  LEADING  TO  INDIGESTION. 

SECTION  1. — Eating  too  little.  SECTION  2. — Eating  too  much.  SECTION  3. — Seden- 
tary habits.  SECTION  4. — Tight  lacing.  SECTION  5. — Compression  of  the  epi- 
gastrium by  shoemakers.  SECTION  6. — Sexual  excess.  SECTION  7. — Solitude. 
SECTION  8. — Intellectual  exertion.  SECTION  9. — Want  of  employment.  SEC- 
TION 10. — Abuse  of  purgatives.  SECTION  11. — Abuse  of  alcohol.  SECTION  12. — 
Tobacco.  SECTION  13. — Tea.  SECTION  14. — Opium. 

IN  the  cases  cited  in  the  last  chapter  the  causes  of  the  indi- 
gestion were,  as  a  rule,  out  of  the  power  of  the  patient  to  modify. 
Nobody  for  their  own  pleasure  falls  into  poverty,  catches  cholera, 
is  ruined  in  trade,  lives  upon  potatoes,  is  worried  by  clients, 
nurses  the  dying,  &c. ;  or  at  all  events  they  do  it  with  the  hope 
of  reward  here  or  hereafter,  and  it  is  useless  telling  them  not. 
The  complaint  cannot  be  cured  by  removing  the  cause :  either 
it  is  past  and  gone ;  or  it  is  incapable  of  being  removed,  as 
much  out  of  our  control,  as  the  changeable  weather  which  in 
some  cases  brought  on  the  complaint. 

In  this  chapter  I  purpose  discussing  some  of  the  habits  of 
social  life  which  are  in  a  great  measure  voluntary,  which  do  not 
promise  any  sufficient  reward,  which  are  persisted  in  by  reason- 
able persons  principally  from  ignorance,  and  which  therefore  we 
can  require  our  patients  to  give  up,  as  the  principal  step  towards 
their  cure.  "  Sulaltd  causa  tollitur  effectus"  is  a  very  practical 
motto  when  the  cause  is  not  too  heavy  for  us  to  lift. 

SECTION  I. 

Eating  too  little. 

I  do  not  know  of  anything  which  more  excites  our  wonder 
in  reading  contemporary  sketches  of  the  social  life  of  our  fore- 
fathers than  the  gross  manner  in  which  they  indulged  their 


HABITS    LEADING    TO    INDIGESTION.  93 

To  pass  over  the  bestialities  of  the  philosophic 
heathen,  as  recorded  by  Juvenal  and  Petronius,  our  disgust  is 
equally  aroused  in  civilized  Christian  times  by  the  mighty 
emperor  warrior  and  statesman  Charles  V  washing  down  his 
six  or  seven  daily  meals,  his  supper  at  midnight  and  his  heavy 
breakfast  at  six  in  the  morning,  with  great  draughts  of  beer 
and  wine,  whether  in  camp  or  cloister,  or  by  his  saturnine  son 
Philip  racking  his  stomach  with  enormous  loads  of  pastry  till 
the  chronic  gastralgia  visible  in  his  countenance  became  a 
prominent  feature  in  his  portraits,  or  by  the  genial  coarseness 
of  our  middle  classes  as  photographed  by  Chaucer  with  sympa- 
thetic appreciation  of  all  that  is  human.  One  is  not  surprise  1, 
in  reading  such  unconscious  records  of  deficient  control  over 
the  animal  propensities,  at  theologians  and  physicians  both 
preaching  the  opposite  extreme,  and  placing  abstinence  in  the 
niche  sacred  to  temperance.  Hence  springs  the  popular  notion, 
too  deeply  rooted  by  long  growth  for  increased  knowledge  to 
dissipate  under  several  generations,  that  abstinence  is  a  sine  qud 
in  all  medical  treatment,  and  is  a  cure  for  all  disease. 

CASE  LVI. — In  November,  1856,  J.  M.  V — ,  a  young  mercantile  man,  aged 
36,  came  to  me  for  slight  flatulence  and  constipation.  I  gave  him  some  Myrrh 
and  Aloes  pills  to  take  occasionally,  and  saw  no  more  of  him  then.  He  went 
on  very  well  till  1860,  when  he  was  persuaded  by  some  foolish  friend  to  adopt 
a  system  of  extreme  abstinence,  not  that  his  health  was  to  be  called  bad,  but 
he  wanted  it  to  be  better  than  good.  The  consequence  was  a  relapse  into  a 
state  much  worse  than  the  first.  Three  or  four  hours  after  eating,  flatulence 
bursting  upwards  from  the  stomach,  rolling  about  in  suppressed  thunder 
among  the  intestines,  or  passing  off  by  the  rectum,  used  to  cause  great  in- 
convenience, especially  by  night.  And  the  absence  of  taste  and  smell  in  the 
ev;i«-u;ited  air  showed  it  to  be  the  carbonic  acid  of  decomposed  amylaceous 
food.  The  nervous  system  was  equally  deranged.  There  was  great  wake- 
fulness  in  bed,  and  an  inability  to  apply  the  mind  to  anything  l>y  day,  which 
steadily  increased  upon  him,  and  prevented  his  attending  to  his  business.  I 
gave  him  some  Quinine,  and  desired  him  immediately  to  resume  a  full  flesh 
diet.  A  week  afterwards  he  came  and  said  the  flatulence  and  other  symp- 
toms were  very  much  better,  but  the  full  dose  of  Quinine  made  his  head 
ache.  He  was  ordered  then-fore  to  take  only  half  a  grain  twice  a  day,  to 
keep  u]>  his  appetite  to  its  work;  and  then  he  was  able  to  engage  again  in 
business  so  as  to  think  no  more  about  his  health. 

Instead  of  decreasing  the  dose  of  Quinine,  I  have  often  simply 
added  six  or  eight  minims  of  Chloric  Etber  to  each  draught, 


94  HABITS    LEADING    TO    INDIGESTION. 

and  have  found  it  quite  effectual  in  preventing  headache.  This 
was  in  cases  where  I  chanced  to  be  very  anxious  to  have  the 
full  dose  taken.  Here  I  did  not  think  the  magnitude  of  the 
dose  important. 

That  Quinine,  however,  or  some  equivalent  nerve-renewer  is 
valuable  in  such  cases  I  feel  persuaded  by  the  rapidity  with 
which  patients  get  well  under  its  use,  and  the  long  convales- 
cence they  have  without. 

CASE  LVIL— Miss  H.  W— ,  January  28, 1860.  The  patient  is  a  very  thin, 
nervous-faced  young  woman  of  twenty-three,  who  complains  of  a  weight  at 
the  pit  of  the  stomach  brought  on  by  swallowing  any  solid.  This  first  began 
eighteen  months  ago  at  a  catamenial  period,  and  she  immediately  persuaded 
the  family  doctor  to  interdict  all  solid  food,  and  she  has  taken  none  ever  since. 
She  has  lost  21  pounds  in  weight,  though  never  stout  previously,  and  has 
become  dreadfully  flatulent  and  hysterical.  The  heart  has  become  weak  and 
irregular  in  strength,  and  sometimes  intermittent. 

She  was  a  long  time  in  recovering  even  under  an  improved  dietary,  so 
that  I  find  noted  in  April,  1861,  that  though  her  muscles  had  become  firm 
and  the  general  health  good,  yet  there  was  still  some  pain  at  the  epigastrium 
after  dinner,  which  I  attributed  to  tight  lacing. 

I  attributed  it  at  the  time  to  tight- lacing,  but  I  have  seen 
reason  afterwards  to  view  it  as  one  of  the  consequences  of  her 
condition,  to  deficient  nerve-power  in  the  stomach. 

Even  in  much  more  chronically  ingrained  disease  of  much 
longer  duration  than  in  the  instances  cited  a  partial  improve- 
ment may  be  effected  very  quickly  by  the  aid  of  drugs. 

CASK  LVIII. — The  Rev.  J.  S — ,  a  parish  priest  and  Union  chaplain,  aged 
48,  in  February,  1866,  tells  me  that  when  reading  hard  for  his  degree  at  the 
University  he  first  became  sensible  of  pain  after  eating.  His  theory  was 
that  he  ought  to  eat  less ;  and  so  he  did,  less  and  less ;  and,  with  the  hope  of 
working  a  cure  all  at  once,  actually  lived  a  whole  year  on  bread  and  water 
only.  In  consequence  he  is  troubled  with  flatulence,  debility,  and  frequent 
attacks  of  palpitation  of  the  heart.  The  pulse  is  uneven,  and  occasionally 
intermits.  As  far  as  I  can  ascertain  by  questioning,  he  feels  more  pain  now 
after  eating  than  he  used  to  when  he  began  this  ascetic  life  nearly  a  quarter 
of  a  century  ago. 

A  generous  animalized  diet,  taken  frequently,  with  wine,  Quinine,  and 
Strychnine,  while  at  the  same  time  the  oversensitive  nerves  were  deadened. by 
Opium  and  Hydrocyanic  acid,  enabled  me  to  allow  him  to  return  home  in  ten 
days ;  but  I  of  course  did  not  promise  that  he  would  ever  be  the  man  he 
might  have  been  naturally  under  a  rational  dietary. 


HABITS    LEADING    TO    INDIGESTION.  95 

On  July  17th  he  tells  me  he  is  able  to  eat  more  and  more  without  pain 
week  by  week.  His  pulse  is  regular,  and  he  has  no  flatulence.  He  has  left 
off  all  medicine  except  ;i  quarter  of  a  irrain  of  Opium  every  night.  He  is 
more  robust  than  ever  I  expected  to  see  him. 

The  above  is  an  instance  how  ascetism  will  be  persisted  in  on 
theoretical  grounds  in  spite  of  nature's  daily  warnings  to  the 
contrary,  and  how  unobservant  even  highly  educated  people 
are  of  physical  facts.  How  one  whose  profession  makes  him 
daily  conversant  with  the  poor  and  down-trodden,  while  his 
!  habits  throw  him  among  the  rich,  can  fail  to  remark  the 
symptoms  of  deficient  diet,  is  difficult  for  us  physicists  to  under- 
stand. 

I  used  the  word  "  ascetism"  in  the  last  observation.  Perhaps 
it  was  hardly  right  to  do  so ;  for  though  in  familiar  conversation 
applied  to  abstinence  from  pleasure  with  whatever  intention, 
such  is  not  its  proper  meaning,  and  it  ought  strictly  to  be  con- 
fined to  those  self-restraints  where  the  motive  is  nobler  than  the 
mere  bodily  health,  where  it  is  an  active  devotional  exercise,  a 
mode  of  honoring  God. 

Where  this  form  of  devotion  is  part  of  the  established  worship 

of  any  religious  community,  it  is  usually  made  the  subject  of 

minute  regulations,  designed  with  a  view  of  securing  practical 

Ita  without  injury  to  sanitary  condition.     The  principles  of 

these  regulations  seem  to  be  that  abstinence  should  not  be  ex- 

ve,  and  above  all  not  continuous.     Moreover,  the  spiritual 

patient  is  never  to  prescribe  for  himself. 

In  the  Church  of  England  it  certainly  does  not  constitute 

any  portion  of  the  regular  religious  services  demanded  of  its 

members.     Truly  in  the  homily  "On   Fasting"  a  low  diet  on 

in  days  is  urged ;  but  the  preacher  destroys  the  force  of  his 

advice  by  inserting  the  weakening  argument  that  its  general 

adoption  would  be  a  great  encouragement  to  our  fisheries.     The 

method  o  i>m  being  thus  left  to  individual  management, 

its  intention  is  often  mistaken,  and  its  practice  abused.      Instead 

of  looking  upon  it  as  an  exercise,  as  a  sacrificial  service,  in  its 

intermittent,  occasional,  and  departing  from  its  essence 

it'  not  intermittent  and  occasional,  men  treat  it  as  a  me- 

"ying  the  instinctive 


96  HABITS    LEADING    TO    INDIGESTION. 

CASE  LIX. — Last  February  (1866)  an  Anglican  rector,  aged  32,  consulted 
me  on  account  of  increasing  inability  to  perform  the  duties  of  his  ministry. 
Fits  of  mental  depression  more  and  more  frequently  came  over  him,  accom- 
panied by  a  feeling  of  loss  of  volition  over  the  limbs.  At  all  times  he  was 
weak  and  incapable  of  muscular  exertion,  and  was  thrown  into  a  cold  sweat 
by  any  bodily  or  mental  effort.  There  was  loss  of  appetite,  pain  at  the  epi- 
gastrium and  flatulence  after  eating,  with  palpitation  of  the  heart.  This  local 
condition  of  the  stomach  seemed  to  have  been  more  prominent  a  symptom 
previous  to  his  visit  to  me,  for  I  remarked  that  the  pit  of  the  stomach  had 
been  blistered,  by  the  advice  of  a  former  physician  I  presume.  This  state  of 
things  had  been  gradually  coming  on  for  about  two  years.  He  had  several 
times  taken  short  holidays,  but  with  no  permanent  benefit. 

On  conversation  with  him,  I  found  his  notion  of  the  relation  between  soul 
and  body  was  that  of  a  constant  antagonism.  It  seemed  to  him  that  the  aim 
of  the  former  should  be  to  subdue  the  latter  continuously  and  permanently — 
not  only  to  knock  it  down,  but  to  keep  it  down.  He  ate  merely  to  enable 
him  to  visit  and  preach  and  pray ;  he  drank  whatever  liquid  came  first ;  he 
had  married  because  the  world  must  be  peopled,  and  because  he  wanted  a 
help-meet  in  his  work.  But  he  rejoiced  when  his  appetite  failed,  and  when 
he  felt  no  pleasure  in  his  victuals  or  wish  for  wine ;  and  as  soon  as  his  sweet 
young  wife  had  borne  him  two  children,  they  ceased  by  mutual  consent  from 
bodily  matrimonial  intercourse.  The  last-named  final  blow  to  the  flesh  had 
been  given  four  years  before. 

(March,  1867).  A  year's  complete  rest,  and  a  constant  recurrence  to 
Quinine  and  Strychnia,  have  been  necessary  before  he  could  be  pronounced 
fit  for  the  duties  of  his  profession,  as  I  have  certified  him  now  to  be. 

Surely  this  is  Stoicism  or  Gnosticism,  rather  than  the  religion 
of  the  Bible.  I  am  not  fond  of  preaching,  especially  to  clergy- 
men, or  of  turning  texts  into  traps;  but  people  should  not 
forget  the  threatenings  at  the  end  of  Ecclesiastes,  where  we  are 
told  that  God  will  bring  us  to  judgment  and  make  us  account 
for  our  missed  opportunities  of  enjoyment,  for  not  being  cheer- 
ful in  our  youth  and  loving  the  beautiful ;  and  where  we  are 
urged  on  those  grounds  to  "  remove  sorrow  from  the  heart  and 
put  away  evil  from  thy  flesh."  Forgetfulness  in  youth  of  the 
Creator  and  His  creatures,  disregard  of  the  Giver  as  exhibited 
in  His  gifts,  and  neglecting  to  render  Him  thanks  by  using 
them,  always  entails  a  punishment  on  either  mind  or  body.  A 
joyless  man  becomes  an  unhealthy  man ;  in  body  if  they  are 
bodily  joys  that  he  has  foregone,  in  mind  if  they  are  mental. 


HABITS    LEADING    TO    INDIGESTION.  97 

SECTION  II. 
Eating  loo  much. 

Habitual  gluttony  is  as  rare  now  as  it  was  common  in  the 
ilays  of  old.  An  occasional  careless  excess  in  the  pleasures  of 
the  table  may  be  indulged  in,  but  people  feel  it  to  be  an  excess, 
promise  themselves  that  it  shall  be  only  occasional,  and  do  not 
go  to  a  doctor  for  its  consequences.  It  suggests  and  often 
spontaneously  carries  out  its  own  cure,  and  the  shame  which 
accompanies  it  causes  the  "  remorse  of  a  guilty  stomach"  usually 
to  be  concealed.  So  that  I  have  no  notes  on  the  subject  to 
quote. 

I  can,  however,  remember  two  instances  where  over-eating 
really  deserved  sympathy  rather  than  contempt,  and  I  will 
transcribe  one  of  them  here,  it  being  always  pleasanter  to  reflect 
the  bright  than  the  dark  side  of  human  nature.  I  dare  say  I 
shall  find  some  future  opportunity  of  introducing  the  other  also. 

I  LX. — In  November,  1859, 1  was  requested  to  visit  a  lady  past  middle 
life,  who,  when  I  entered  her  library,  certainly  looked  the  picture  of  robust 
bloom.  "Dr.  Chambers,"  said  she,  "what  is  a  British  matron  to  do  who 
habitually  eats  too  much  ?"  The  question  suggested  the  shortest  of  replies. 
••  A\v,  it's  very  easy  for  you  to  say  'Don't;'  but,  if  I  didn't,  I  should  be  a 
willow  in  a  week.  You  know  how  old  and  infirm  Lord  C —  is.  He  has 
always  been  used  to  feed  highly,  and  if  I  cut  the  dinner  short,  or  did  not 
encourage  him  by  my  example,  it  would  be  his  death."  It  seemed  that  the 
symptoms  of  eating  too  much  were  a  sense  of  repletion  and  a  want  of  sleep 
during  the  night,  feverishness  in  the  morning,  a  sort  of  worrying  fidget  in  the 

!•,  sometimes  followed  by  constipation,  sometimes  by  fetid  semi-liquid 
evacuations,  never  by  natural  motions,  frequent  headaches,  and  a  tendency 
to  depression  of  spirits.  Sometimes  she  was  attacked  in  the  night  by  what 
she  called  "spasms,"  that  is  to  say,  severe  pain  in  the  epigastric  and  umbilical 

as.  If  that  ended  in  vomiting  she  experienced  rapid  relief,  and  was  bet- 
ter than  usual  for  several  days. 

My  prescription  was  an  Aloes  and  Myrrh  pill  before  dinner  daily,  and  a 
recommendation  of  a  dry  diet  as  mixed  ami  varied  as  possible,  avoiding  only 
soup,  slops,  butter,  and  Int.  I'.ut  I  doubt  if  it  was  quite  successful,  till  the 

ug  cause  of  this  virtuous  intemperance  bore  his  many  years  and  honors 
to  the  grave. 

I  question  if  my  recommendation  of  a  mixed  diet  was  v. 
It  would  have  been  better  for  her  to  have  taken  a  prepouder- 
7 


98  HABITS    LEADING    TO    INDIGESTION. 

ance  of  meat  one  day  and  a  preponderance  of  vegetables  another, 
but  more  generally  the  latter. 

The  majority  of  exceeders  have  not  such  a  good  excuse  for 
their  violation  of  the  rules  of  propriety,  and  would  with  reason 
suppose  themselves  to  be  laughed  at  if  asked,  "  'Is  it  for  fear  to 
•wet  a  widow's  eye'  that  you  eat  so  much?"  They  seldom  have 
the  discernment  shown  by  the  last-named  patient  in  recognizing 
the  habit  which  is  the  cause  of  their  ill-health ;  but  they  are 
ready  enough  to  give  it  up  when  brought  to  see  that  they  are 
committing  a  contemptible  excess. 

CASE  LXT. — Mrs.  L — ,  aged  32,  the  wife  of  a  rich  manufacturer,  came  to 
me  in  the  spring  of  1860,  complaining  of  a  weight  and  distension  felt  at  the 
epigastrium  half  an  hour  after  meals,  and  lasting  for  several  hours.  It  was 
followed  by  eructations  or  returns  of  small  quantities  of  food,  not  sour  and 
not  accompanied  by  flatulence.  The  bowels  were  loose,  the  motions  never 
formed,  but  ragged,  and  sometimes  diarrhceic.  There  was  a  nasty  taste  in 
the  mouth  in  the  morning,  feverish  and  restless  nights,  and  frequent  dull  head- 
aches, with  low  spirits  and  hysteria.  The  catamenia  were  irregular  and  some- 
what profuse.  She  said  that  these  symptoms  had  commenced  nearly  two 
years  previously,  when  her  husband  had  some  pecuniary  troubles.  I  ques- 
tioned her  strictly  as  to  keeping  up  her  spirits  by  indulging  in  alcohol  at  that 
time  or  since,  and  believed  her  not  guilty.  But  she  confessed  to  having 
become  very  fond  of  good  eating,  and  having  a  great  appetite  for  anything 
"nice."  She  was  a  large-framed  woman,  and  comely,  though  her  outline  was 
growing  rather  out  of  drawing. 

Eemark  how  in  a  weaker-minded  person  the  mind  becomes 
affected,  while  the  more  robust  and  educated  intellect  shown  in 
the  previous  case  bears  up  and  gains  strength  by  resistance. 

The  error  in  diet  which  in  a  woman  produces  hysteria,  in  a 
man  declares  itself  by  melancholy. 

CASE  LXII. — Richard  R — ,  aged  48,  a  white-faced  and  fat  clerk,  came  to 
me  a  month  ago,  November,  1866,  persuaded  that  he  had  diseased  heart  by 
the  palpitations  of  that  organ  which  he  experienced,  especially  in  the  morning. 
He  had  lost  interest  in  life,  having  succeeded  in  obtaining  a  comfortable  in- 
come more  than  sufficient  for  his  wants,  and  having  laid  by  a  provision  for 
old  age.  He  was  passing  a  drab-colored  existence,  taking  no  pleasure,  fol- 
lowing no  hobbies,  and  occupied  only  with  the  routine  of  his  office  and  atten- 
tion to  his  health.  Of  the  latter  he  had  a  bad  opinion,  and  considered  that  he 
was  delicate  and  required  abstinence  from  excitement  and  constant  support. 
Besides  his  regular  meals  he  was  in  the  habit  of  taking  a  slight  anticipatory 


HABITS    LEADING    TO    INDIGESTION.  99 

lumheon  at  11.  an  intercalary  snack  at  4  preparatory  to  dinner  at  6,  and  a 
small  refresher  along  with  his  glass  of  grog  at  bed-time.  The  consequence 
was  sleepless  nights,  flatulence  of  stomach,  palpitations  of  heart,  returns  of 
small  quantities  of  food  by  the  oesophagus,  irregularity  of  stools,  increased 
y,  and  desponding  views  concerning  time  and  eternity.  To  his  great 
terror,  I  made  him  go  quickly  up  and  down  stairs,  and  examined  the  heart, 
the  sounds  and  beat  of  which  were  quite  natural  after  this  natural  excitement 
But  the  stomach  was  large,  and  gave  a  drummy  sound  on  percussion  quite  up 
U>  the  apex  of  the  ventricle.  A  counsel  to  leave  off  bacon  at  breakfast,  to 
eat  i'uly  at  meal-times,  and  a  short  course  of  Hydrochloric  Acid,  made  a  new 
man  of  him. 

How  easily  such  a  person  as  this  might  be  turned  into  a 
hypochondriac  or  a  lunatic  by  coddling  and  sympathizing! 

If  the  last  patient  had  really  got  a  diseased  heart,  I  should 
have  given  him  probably  a  treatment  not  very  different  in  prin- 
ciple, but  I  should  have  especially  cautioned  him  against  gorg- 
ing himself  even  at  meals.  For  now  and  then  cases  occur  like 
the  following. 

CASK  LXIII. — John  B — ,  aged  71,  a  cheerful  old  gentleman,  came  to  me 
in  May.  If.VJ.  He  said  he  had  always  taken  great  care  of  his  health,  but  had 
not  consulted  a  medical  man  since  he  had  rheumatic  fever  at  fifteen  years  of 
age.  His  reason  for  taking  care  of  his  health  had  been  a  tendency  to  short- 
ness of  breath,  which  he  said  he  had  experienced  so  long  ago  as  the  beginning 
of  the  ceutury,  when  reading  Shakspeare  to  the  young  ladies  of  the  period. 
Examination  of  the  heart  showed  it  to  be  very  weak,  irregular  in  time  and 
strength,  with  a  confusion  in  its  valve  sounds,  and  a  dulness  on  percussion 
extending  four  inches  in  width  from  the  epigastric  across  the  cardiac  region. 
The  pul-i-  at  the  wrist  was  equally  weak.  He  had  always  enjoyed  his  table, 
but  latterly  had  found  that  taking  the  quantity  requisite  to  satisfy  him 
oppressed  his  chest  and  made  him  faint.  Nobody  could  discern  better  than 
the  patient  himself  the  true  pathology  of  his  case,  nor  give  better  advice  than 
his  own  reason  suggested.  But  unfortunately  he  was  not  able  to  follow  it,  for 
a  few  weeks  afterwards  I  had  a  letter  from  young  Mr.  B — ,  saying  that  his 
father  had  eaten  heartily  of  an  indigestible  mixed  dinner,  and  lay  back  in  his 
chair  dead. 

It  very  often  excites  the  astonishment  of  these  patients,  after 
having  it  explained  to  them  that  their  danger  lies  in  over-eating, 
to  be  told  to  increase  the  number  of  their  meals.  Yet  such  is  in 
most  instances  the  best  way  of  meeting  the  case.  Small  quan- 
tities frequently  taken  are  the  best  device  for  introducing  a  full 
supply  of  nutriment  without  overloading  the  alimentary  canal. 
During  the  day,  four  hours  is  the  longest  time  that  an  invalid 


100  HABITS    LEADING    TO    INDIGESTION. 

should  be  allowed  to  pass  without  eating  something ;  and  for 
some  two  hours  is  a  sufficient  interval.  Very  soon  the  appetite 
begins  to  accommodate  itself  to  these  habits,  and  the  little  meal 
that  is  committed  to  the  stomach  at  once,  instead  of  lying 
dormant  in  the  paralyzed  organ  for  hours,  as  was  the  case  under 
former  customs,  is  enabled  to  pass  away  rapidly. 

The  excess  in  eating  is  not  uncommonly  rather  relative  than 
positive.  It  would  not  be  an  excess  under  normal  circum- 
stances, but  it  is  made  so  by  those  present.  Of  this  acute  examples 
are  given  in  cases  IX,  X,  XI,  in  the  last  chapter,  where  an 
ordinary  meal  was  an  excess  under  extraordinary  temporary 
circumstances.  The  following  is  a  chronic  result  of  a  chronic 
cause. 

CASE  LXIV. — T.  J — ,  a  lawyer,  naturally  inclined  to  be  corpulent,  aged 
52,  was  well  till  October,  1865,  when  he  sprained  his  ankle  rather  severely. 
He  was  always  used  to  a  good  deal  of  bodily  exercise,  and  of  course  in  his 
profession  equally  employed  his  mind  ;  so  that  it  was  not  to  be  wondered  at 
that  he  habitually  fed  largely.  This  did  him  no  harm  till  the  accident  to  his 
leg,  after  which  he  began  to  suffer  from  indigestion.  The  bowels  were  cos- 
tive, and  the  stools  never  homogeneous,  but  consisting  of  rags  of  solid  matter 
in  much  fluid ;  he  had  acid  risings  in  the  mouth,  eructations,  wind  rolling 
about  at  night  in  the  intestines,  and  breaking  off  per  anum  in  the  morning. 
What  most  distressed  him  and  brought  him  under  my  care  was  want  of  rest 
at  night.  He  either  could  not  sleep  at  all,  or  else  woke  up  after  a  short  nap 
and  could  sleep  no  more.  Opiates  had  made  him  worse.  Worried  in  this 
way,  he  had  lost  two  stone  in  weight  in  the  six  months  since  his  illness  began, 
and  appeared  to  have  been  striving  to  replace  the  loss  of  flesh  by  keeping  up 
his  usual  high  feeding.  But  analysis  of  the  urine  showed  that  there  was  no 
lack  of  active  metamorphosis  going  on,  for  it  was  at  all  times  of  the  day  fully 
acid,  clear,  and  with  a  constant  specific  gravity  of  1.024  to  1.025,  varying 
singularly  little  with  circumstances.  He  was  nervous  and  irritable,  and,  like 
all  nervous  people,  had  a  smooth,  white  tongue.  There  is  small  doubt  but 
what  a  return  to  active  habits  would  have  restored  his  usual  health,  but  un- 
fortunately some  remains  of  lameness  precluded  it.  He  was  astonished  when 
told  he  ate  too  much,  and  doubted  if  that  was  possible  when  a  man  was  losing 
flesh.  But  experiment  proved  to  him  what  the  symptoms  led  me  to  pro- 
nounce, namely,  that  the  ingesta  were  in  excess  of  what  was  required  for  the 
nutrition  at  the  time,  though  they  were  not  too  much  for  him  when  he  was 
living  more  actively. 

In  this  instance  the  headache  which  frequently  accompanies 
excess  of  mixed  diet  was  absent. 
The  loss  of  flesh  is  interesting. 


HABITS    LEADING    TO    INDIGESTION.  101 

Loss  of  flesh  is  rather  an  exceptional  accompaniment  of  the 
dyspepsia  of  excess.  The  following  is  a  much  more  common 
case,  causing  me  a  little  difficulty  in  selection,  so  many  are 
alike. 

CASE  LXV. — Mrs.  II — ,  a  very  stoat  lady  of  about  sixty,  came  to  me  in 
June,  1KV2,  to  consult  principally  about  her  obesity.  But  I  found  her  a 
martyr  to  gastric  dyspepsia,  which  produced  a  feeling  of  emptiness  only  to 
lie  Mil-veil  tiy  taking  food.  This  overeating  increased  her  dyspepsia,  so  that 
she  had  a  constant  diarrhcea,  and  frequent  vomiting.  Yet  with  all  this  her 
corpulence  increased  more  and  more.  Restriction  of  diet  relieved  her  stomach 
symptoms  considerably,  but  her  bulk  was  unreduceable.  I  believe  the  cause 
of  her  death  some  years  afterwards  was  pneumonia. 

Dyspepsia  certainly  does  not  prevent  corpulence.     In  thirty  - 
os  of  obese  persons,  which  I  printed  in  a  tabulated  form 
some  \ -ears  ago1,  five  of  the  number  suffered  in  this  way.     In 
t  is  not  impossible  that  one  cause  of  that  hypertrophy  may 
ie  delay  of  the  victuals,  both  animal  and  vegetable,  in  the 
stomach,  and  the  setting  up  in  the  carbonaceous  material  of  a 
fermentation  instead  of  digestion.    This  obesity  of  persons 
with  weak  gastric  digestion  is  peculiarly  distressing:  the  defect 
in  muscular  power  prevents  the  use  of  exercise  for  a  time  suffi- 
cient to  prevent  its  increase,  and  hence  it  becomes  a   daily 
«rro win  i:  inconvenience.     The  encroachment,  too,  of  the  adipose 
11  pmi  the  other  tissues,  and  the  dilute  spread  of  the  insufficient 
blood  through  an  unnaturally  large  quantity  of  capillaries,  tend 
to  produce  atrophy  of  important  parts;  and  hence  we  find  as 
consequences  of  corpulence,  dilatations  and  degenerations  of  the 
heart,  fatty  deposits  on  the  same,  Bright's  kidneys  with  dropsy, 
&c.     The  addition  of  many  pounds  to  the  body  in  the  shape  of 
fat,  i  --ertainly  a  very  large,  although  not  perhaps  a  pro- 

portionate, addition  of  blood  and  bloodvessels  to  nourish  it; 
.line  In-art  has  still  to  undertake  this  extra  labor.     The 
balance  then  between  the  systemic  and  the  pulmonary  circula- 
tion must  be  destroyed,  and  the  lungs  be  unequal  to  the  excre- 
-  of  so  much  more  carbon  than  they  were  intended  to  pro- 
vide r<>r:  hence  the  blood  becomes  more  venous,  more  liable  to 
form  congestions,  and  to  dilate  the  yielding  walls  of  the  heart 
by  its  retarded  pace.     The  elVect  of  diminished  circulation  in 

1  "  On  Corpulence,"  p.  139.     London,  1850. 


102  HABITS    LEADING    TO    IXDIGESTIOX. 

also  producing  degeneration  of  other  parts  need  not  be  enlarged 
upon. 

SECTION   III. 

Sedentary  habits. 

Among  the  originators  of  dyspepsia  we  commonly  find  in- 
cluded in  books  sedentary  habits.  But  when  I  come  to  look  over 
my  notes,  I  cannot  extract  any  cases  which  would  exhibit  this 
fact.  I  do  not  know  by  experience  if  a  sedentary  life,  such  as 
that  of  a  clerk  or  bookkeeper  for  example,  would  induce  the 
defect  unless  it  were  joined  to  some  other  cause.  Alone,  with  a 
properly  regulated  diet,  it  seems  consistent  with  quite  healthy 
digestive  powers.  We  find  it  so  in  the  bed-ridden  under  our 
care,  whose  life  may  be  viewed  as  the  type  of  a  sedentary  one, 
yet  they  do  not  suffer  except  from  some  more  than  ordinary 
folly  in  diet,  or  from  the  misuse  of  some  drug. 

When  therefore  those  who  come  before  us  for  indigestion 
attribute  their  state  to  a  sedentary  life,  we  must  not  stop  there, 
but  search  further  for  other  and  more  certain  causes.  For 
example : — 

CASE  LXYI. — M.  S — ,  editor  of  a  weekly  newspaper,  aged  about  forty, 
laid  on  the  many  hours  he  spent  in  the  office-chair  the  blame  of  enteric  dys- 
pepsia, which  spoilt  his  night's  rest  by  waking  him  in  the  early  morning  with 
flatulence.  Charcoal  gave  him  only  temporary  relief,  but  dividing  his  meals 
more,  taking  a  good  luncheon  and  a  light  dinner,  seems  to  have  set  him  up 
completely.  This  was  in  1856,  and  now  he  seems  quite  equal  to  his  official 
duties,  and  looks  as  robust  as  any  leucophlegmatic  men  ever  do. 

Let  it  not  be  supposed  that  I  underrate  the  value  to  health  of 
exercise  in  the  open  air.  The  fresh  oxygen,  the  cheerful  occu- 
pation, the  distraction  of  the  mind  from  injurious  tension,  must, 
however,  be  taken  into  account  by  the  physiologist,  and  not  all 
the  benefit  set  down  to  muscular  motion,  which  latter  element 
is  but  a  small  part  of  what  is  usually  included  under  the  recom- 
mendation of  "  exercise"  by  a  rational  physician.  I  have  come 
across  more  brain-laborers  whose  digestion  has  been  injured  by 
injudicious  excess  in  muscular  exertion  than  by  the  reverse. 
Let  not  those  whose  avocations  are  necessarily  sedentary,  despair 
of  finding  by  judicious  experiment  a  mode  of  passing  their  lives 
in  complete,  though  not  of  course  blooming  health. 


HABITS    LEADING    TO    INDIGESTION.  103 

The  division  and  arrangement  of  the  meals  according  to  the 
me  >de  of  life  is  a  very  important  part  of  the  science  of  digesting 
them.  Much  must  be  left  to  individual  experience,  but  regular 

try  men,  and  others  who  do  routine  work  at  the  desk,  I 
generally  find  are  better  for  taking  a  meat  luncheon  and  only  a 
liuht  dinner  after  the  day's  labor.  And  if  they  take  a  glass  of 

.  it  should  be  at  bed-time.  Great  late  meals  washed  down 
with  a  quantity  of  alcohol  do  not  suit  them. 

On  the  other  hand,  those  who  pass  a  muscular  life  often  suffer 
from  eating  in  the  middle  of  the  day.     For  instance,  I  recom- 
led  the  following  to  dine  late,  and  to  take  at  most  a  glass 
of  wine  and  a  biscuit  in  the  middle  of  the  day. 

LX  V II. — A.  W — ,  a  schoolmaster,  always  dined  with  his  boys  at  one 
o'clock,  and  tried  to  work  off  his  dinner  by  playing  at  cricket  with  them  in 
tin-  afternoon.     But  the  more  he  played  at  cricket  the  more  he  suffered  from 
•rnfort  at  the  epigastrium  followed  by  intense  headache. 

R  LXVIII. — A  Welsh  country  gentleman,  aged  57,  was  under  my  care 

in  1-62  for  weight  at  the  epigastrium,  acid  efuctations,  headache,  and  sleep- 

••*a.     He  said  the  beginning  of  it  was  over-smoking  at  Cambridge;  but 

since  then  he  had  been  to  a  number  of  physicians,  and  taken  a  great  deal  of 

mrilioine,  homoeopathic  and  allopathic.     He  had  been  in  the  habit  of  much 

ise,  and  always  dined  at  two  o'clock.   Dining  late  relieved  his  symptoms, 

but  he  did  not  seem  satisfied  without  medicine. 

Laborers,  sportsmen,  pedestrians,  postmen,  are  all  instances 
of  ready  access,  from  whom  it  is  easy  to  learn  that  habitually  to 
eat  heavily  during  the  hours  of  bodily  toil  produces  sooner  or 
later  indigestion,  and  that  health  and  comfort  are  secured  by 
making  supper  the  principal  meal. 

SECTION   IV. 

Tight-lacing. 

One  wet  winter  day  at  Florence  I  had  been  spending  the 
morning  in  the  studio  of  a  sculptor  of  world-wide  reputation. 
AV>'  had  discussed  the  perfections  of  female  beauty,  and  I  felt 
that  I  was  sitting  at  the  feet  of  a  thinker,  as  well  as  an  "elegans 
•i rum  spectator"  In  the  evening  we  met  at  a  hospitable 
palazzo,  and  under  cover  of  the  waltz  music  from  a  quiet  corner 
of  observation  saw  whirling  by  us  in  the  llesh  much  that  we  had 


104  HABITS    LEADING    TO    INDIGESTION. 

been  thinking  of  in  the  marble  and  the  clay ;  and  both  our 
eyes  could  not  but  follow  one  particular  face,  famous  for  the 
assistance  its  great  natural  beauty  received  from  art.  "  Face," 
I  said,  but  the  mind  of  Hiram  Powers  was  penetrating  deeper, 
for  he  exclaimed,  after  a  short  silence,  "  That  is  all  very  well, 

but  I  want  to  know  where  Lady puts  her  liver !"   Where, 

indeed !  for  calculating  the  circumference  of  the  waist  by  the 
eye,  allowing  a  minimum  thickness  for  the  parietes  of  the  chest, 
an  area  for  the  spine,  oesophagus,  vena  cava  and  aorta,  the  sec- 
tion of  the  waist  seemed  to  admit  of  no  room  for  anything  else 
at  all.  In  such  a  body  the  liver  must  be  squeezed  down  into 
the  abdomen,  elbow  like  a  big  bully  its  hollow  neighbors,  and 
infringe  upon  their  shape.  Fortunately  for  itself  it  is  singu- 
larly tolerant  of  pressure,  and  may  be  deformed  out  of  all  recog- 
nition by  the  anatomist  of  external  forms,  without  ceasing  to 
do  its  duty  as  a  bile  maker,  as  may  be  seen  well  displayed  in 
Dr.  Murchison's  graphic  woodcuts  in  the  "Medical  Times" 
(March,  1867).  But  yet  the  whole  portal  circulation  must 'be 
carried  on  under  great  mechanical  difficulties,  the  due  supply 
of  arterial  blood  reduced,  and  its  return  by  the  vena  cava 
resisted.  What  an  inconceivably  tough  person  that  must  be 
who  does  not  become  pot-bellied  from  the  downward  pressure, 
red-nosed  from  the  hepatic  obstruction !  And  must  not,  there- 
fore, the  style  of  dress  which  gives  birth  to  such  deformities  be 
an  abomination  and  an  eye-sore  to  the  artist  ? 

The  organ  most  deserving  pity  is  the  unresisting  stomach, 
which  is  dragged  and  pushed  out  of  all  form  during  the  con- 
tinuance of  this  packing  process.  The  longer  the  continuance 
the  more  it  suffers.  If  it  is  constant,  we  get  cases  like  the 
following : — 

CASE  LXIX. — Emily  K — ,  aged  16,  was  a  full-grown  woman  in  form,  and 
had  been  catamenial  for  three  years ;  but  when  admitted  to  St.  Mary's,  in 
March,  1864,  she  was  still  wearing  an  old  tough  black  pair  of  stays  made  for 
her  when  a  child.  The  consequence  was  that  she  had  never  been  thoroughly 
well  all  that  time.  The  catamenia  occurred  every  three  weeks,  and,  for  a 
girl  of  her  age.  were  at  first  profuse,  lasting  six  days ;  but  latterly  they  had 
lasted  only  three  days.  She  had  constant  pain  after  eating,  frequent  vomit- 
ing, and  frequent  rising  of  the  food  in  the  throat,  on  which  latter  occasions 
it  was  sometimes  tinged  with  blood,  especially  at  the  menstrual  periods.  This 
constant  ill-health  had  made  her  thin  and  hysterical,  but  her  lungs,  heart,  and 


HABITS    LEADING    TO    INDIGESTION'.  105 

all  the  solid  organs  seemed  perfectly  normal.  When  admitted  she  was 
vomiting  nil  IUT  meals.  At  first  she  had  Hydrocyanic  Acid,  but  was  no  bet- 
ter in  any  respect  for  it;  but  on  the  6th  of  April  she  was  pat  upon  a  course 
of  cold  showerbaths  every  morning,  with  Valerian  three  times  a  day.  This, 
with  the  removal  of  the  obnoxious  stays,  seems  to  have  been  immediately 
efTcrtual.  for  on  the  l'2th  it  is  reported  she  had  not  vomited  for  two  days,  and 
on  the  18th  she  was  discharged  "cured." 

"Cured" — of  her  stays.  Easy  task  in  such  a  case  as  the 
al>ove,  but  presenting  insuperable  difficulties  much  more  often. 
Women  have  a  very  strong  won't. 

I. XX. — G.'s  "  Anonyma,"1  aged  28,  was  brought  to  me  in  August, 
1859,  by  a  gentleman  whose  mistress  she  then  was.  She  had  borne  several 
children  in  the  course  of  her  career,  but  still  retained  a  beautiful  slim  figure 
which  she  had  when  a  maiden.  This  she  had  accomplished  by  bandaging 
very  tightly  after  each  confinement,  and  sternly  refusing  to  have  any  change 
made  in  the  shape  of  her  corsets.  The  consequence  was  that  for  several  years 
she  never  took  a  meal  without  throwing  some  of  it  up  afterwards,  and  suffered 
from  obstinate  constipation,  for  which  she  was  in  the  habit  of  using  violent 
purgatives.  She  seemed  quite  as  aware  as  I  could  make  her  of  the  cause  of 
vomiting,  but  resolutely  refused  to  do  anything  which  might  imperil  her  out- 
line. In  fact,  she  implied  she  lived  by  her  beauty,  and  intended  to  keep 
it  at  all  hazards. 

I  do  not  know  how  to  answer  an  argument  of  that  sort. 

Another  difficulty  lies  in  the  diagnosis  of  the  true  cause  of 
the  evil.  Asking  questions  is  useless ;  "  aucune  femme  ne  se 
serre,"  remarks  M.  Chomel  of  his  countrywomen,2  and  I  am 
sure  we  may  say  the  same  of  the  confessions  of  ours.  More- 
over, if  you  try  to  detect  them  by  passing  your  hand  under- 
neath the  stays,  as  M.  Chomel  used  to  do,  they  stinge  in,  and 
defend  the  honor  of  their  corset  by  a  fraudulent  kind  of  gym- 
nast ic.  So  you  gain  nothing  by  what  is  in  truth  rather  a  rude 
proceeding.  The  best  way  is  to  make  an  excuse  to  have  the 
clothing  taken  off,  and  observe  whether  it  has  crumpled  and 
marked  the  skin  by  pressure;  then  to  desire  the  patient  to  tab- 
a  full  breath,  and  notice  whether  the  lower  ribs  are  dul\ 

1  I  borrow  this  term  from  the  newspapers  in  no  scoffing  spirit,  but  pitifully  and 
sadly  to  describe  one  who  has  lost  her  maiden  family  name  by  losing  maidcn- 
hood  and  family  ties,  without  ac'iniriiiw'  a  rUht  to  any  other.  It  is  hard  to  smilo 
at  the  loneliness  which  "no  name"  expresses. 

*  "  Lea  Dyspepsies,"  p.  Ii51. 


106  HABITS    LEADING    TO    IXDIGESTIOX. 

panded,  or  whether  the  intercostal  muscles  and  diaphragm  have 
lost  power  by  misuse. 

By  that  means  you  can  find  it  out  when  the  tight-lacing  is 
still  continued  at  the  time  you  see  the  patient.  But  in  most 
cases  it  has  been  left  oft'  on  account  of  the  increasing  pain  it 
causes,  and  a  suspicion  that  it  causes  the  other  symptoms  as 
well ;  or  perhaps  it  is  temporarily  left  off  for  the  visit  to  the 
doctor.  And  I  suspect  that  such  is  the  case  with  a  large  pro- 
portion of  the  instances  of  habitual  vomiting,  soreness  of  epigas- 
trium, of  haematemesis,  of  ulceration  of  the  mucous  membrane, 
flatulence,  and  hysteria,  which  come  before  us.  These  symp- 
toms are  most  common  in  the  other  sex — why  ?  because  their 
reproductive  organs  differ  from  ours  ?  Surely  not,  or  we  should 
find  the  same  peculiarity  universal  among  females  throughout 
the  animal  kingdom,  or  at  least  throughout  mammals.  Yet  we 
read  in  veterinarian  pathology  no  hint  of  a  distinction  between 
the  stomachs  of  our  bulls  and  of  our  cows.  Is  it  not  more 
reasonable  to  conclude  that  the  important  difference  lies  in  the 
clothes,  which  we  can  see,  rather  than  in  some  mysterious  in- 
visible influence  of 'the  generative  viscera  over  the  digestive,  of 
which  there  is  no  evidence  ? 

I  should,  therefore,  in  all  women  where  these  symptoms  ap- 
pear, suspect  at  least,  for  no  harm  is  done  by  the  suspicion, 
tight- lacing,  though  I  should  not  find  it  still  persevered  in  or 
confessed. 

As  an  alteration  of  form  is  sometimes  diagnostically  useful, 
it  may  be  mentioned  that  the  prominent  abdomen  of  a  tight- 
lacer  generally  sticks  out  straight  from  above  the  pubes,  some- 
times overhangs  it:  that  of  a  naturally  short-bodied  stout 
woman  slopes  up  to  the  umbilicus  at  an  angle  of  450.1 

In  a  long-bodied  woman,  such  as  in  the  Phidian  proportion, 
the  abdomen  ought  to  be  flat. 

In  men  there  is  not  the  same  temptation  to  compress  the  viscera 
for  ornamental  purposes  among  those  who  have  the  regulation 
of  their  own  dress.  But  it  has  often  struck  me  that  the  tight 
trowser-bands  and  buttoned-up  uniform  jackets,  which  French 
schools  delight  to  enforce,  must  be  very  unwholesome,  inde- 

1  See  Albert  Durer's  "  Outlines  of  Proportion." 


HABITS    LEADING    TO    INDIGESTION.  107 

pendent  of  the  impediments  they  offer  to  cricket  and  football, 
does  not  wonder  at  the  pale  greasy,  old  looks  of  the  poor 
lads.  They  must  certainly  suffer  from  indigestion,  and  proba- 
bly it  is  this  chronic  ill-health  which  induces  certain  obscene 
habits  said  to  be  common  amongst  them. 

SECTION   V. 
'      pression  of  epigastrium  by  shoemakers. 

Indigestions  such  as  I  have  attributed  to  the  pressure  of  stays 
in  women,  are  common  in  one  class  of  men,  namely,  cobblers ; 
arising  in  them  from  a  cause  of  physiologically  exactly  the 
nature,  the  compression  of  the  epigastrium  by  the  last  on 
which  the  boot  or  shoe  is  worked,  producing  on  the  stomach 
;he  same  effects  as  its  compression  by  the  liver  in  cases  of 
tiirht.-lacing.     The  following  history  shows  the  result  in  an  in- 
cipient stage. 

LXXI. — Joseph  James  D — ,  aged  19,  just  out  of  his  apprenticeship 
-lioemaker,  was  admitted  to  St.  Mary's  Hospital  under  my  care  October 
li'.th.  1861.  He  complained  of  weakness  in  the  wrists,  which  became  painful 
after  work,  and  of  constipation  ;  he  spoke  also  of  pain  in  the  chest,  which  in- 
duced us  to  examine  his  lungs.  These,  however,  were  found  healthy,  and  he 
had  no  cough.  On  further  inquiry  it  appeared  that  the  pain  he  spoke  of  was 
in  th--  epigastrium,  and  was  increased  by  pressure  and  by  taking  food.  Rest 
nml  Quinine  improved  him  rapidly,  so  that  he  was  made  an  out-patient  within 
a  week. 

The  loss  of  power  in  the  wrists,  arising  from  atrophy  of  the 
rmi-eles  in  overworked  parts  of  persons  whose  stomachs  do  not 
take  in  a  sufficient  supply  of  nutriment,  in  some  instances  pro- 
is  to  a  much  greater  degree ;  and  there  is  a  case  recorded 
somewhere  in  my  St.  Mary's  notebooks  of  a  shoemaker  in  whom 
the  two  arms,  even  to  the  deltoids,  were  completely  paralyzed 
by  overwork  in  giving  that  artistic  jerk  to  the  thread  which 
•  workmen  affect.  But  I  cannot  lay  my  hand  on  it  now. 
Perhaps  I  may  find  it  by  the  time  I  come  to  a  future  chapter 
on  the  nervous  symptoms  produced  by  digestive  d 

li'-mark  how  soon  the  evil  had  commenced,  on  the  very 
threshold  of  the  life  the  poor  lad  had  chosen! 

The  next  case  exhibits  a  further  stage  of  the  same  condition. 


108  HABITS    LEADING    TO    INDIGESTION. 

CASE  LXXII. — Philip  B — ,  aged  36,  shoemaker,  was  admitted  into  St. 
Mary's  under  my  care  November  9th,  1855.  He  had  not  been  in  health  for 
nine  years,  suffering  from  what  he  called  "  spasms  in  the  chest,"  that  is,  pain 
across  the  epigastrium,  and  irrepressible  paroxysms  of  belching.  The  pain 
in  the  epigastrium  was  always  increased  immediately  after  taking  food,  and 
was  accompanied  by  a  great  secretion  of  gas.  When  he  could  get  off  some 
of  this  by  eructation,  the  pain  somewhat  abated ;  but  the  eructations  would 
sometimes  continue  as  long  as  three  hours.  During  the  last  nine  months  he 
had  become  emaciated,  and  felt  a  good  deal  of  universal  debility.  The  urine 
was  smoky-colored,  of  the  specific  gravity  only  of  1.010,  though  natural  in 
quantity  and  free  from  albumen ;  the  sleep  was  broken,  the  appetite  good. 
He  stated  that  unless  he  took  purgatives  his  bowels  would  remain  unopened 
for  a  fortnight  together. 

Philip's  first  medicine  was  Bismuth  in  Iron.  But  the  Iron  did  not  seem 
to  agree  with  him  ;  he  got  into  a  feverish  catarrhal  state  and  had  sore  throat. 
During  this  attack  he  was  kept  in  bed,  had  six  leeches  and  afterwards  a  blister 
applied  on  the  epigastrium,  and  took  a  quarter  of  an  ounce  of  Castor-oil  oc- 
casionally. All  this  time,  however,  he  was  gaining  flesh ;  so  that  between 
the  27th  of  November  and  the  10th  of  December  he  had  gained  four  pounds 
in  weight ;  and  the  urine  was  increasing  in  specific  gravity,  so  that,  by  the 
1st  of  December  it  was  1.028,  but  was  a  little  cloudy  from  lythates.  After 
the  acute  febrile  symptoms  had  abated  he  received  much  comfort  from  the 
following  draught  three  times  a  day,  viz. : — 

R. — Mixturse  Rhasi  co.,  fl^j. 
Tincturse  Opii,  TTLV. 
Acidi  Gallici,  gr.  v. 

He  left  on  December  13th,  much  improved  in  health  and  spirits. 

In  this  instance  it  will  be  seen  that  the  evil  was  much  more 
ingrained  by  time,  and  the  symptoms  were  worse  and  more 
difficult  of  relief  in  proportion  to  the  greater  time  it  has  lasted. 

The  intention  of  the  draught  was  to  soothe  the  oversensitive 
nerves  with  the  Opium,  at  the  same  time  that  the  Gallic  Acid 
astringed  the  mucous  membrane,  and  restrained  the  oversecre- 
tion  of  mucus,  which  the  patient's  general  catarrhal  diathesis 
otherwise  displayed  rendered  probable  to  be  present  in  the 
stomach.  The  Rhubarb,  I  think,  was  designed  to  prevent  con- 
stipation arising  from  the  other  ingredients.  As  a  rule  I  like 
Aloes  best  for  that  purpose  in  gastric  cases,  and  I  do  not  know 
why  I  ordered  Rhubarb  here. 

Sometimes  when  lads  begin  shoemaking  early,  before  the 
bones  have  got  quite  hard,  a  peculiar  deformity  is  produced, 
which  acts  like  a  perpetual  pair  of  stays  for  life. 


HABITS    LEADING    TO    INDIGESTION'.  109 

\  XIII. — William  II — ,  aged  25,  bootmaker,  was  admitted  to  St. 
Mary's,  Jane  7th,  1856,  for  pain  at  the  pit  of  the  stomach  which  had  been 
almost  constant  for  tour  years,  and  was  increasing.  The  pain  was  accom- 
panied by  a  local  sensation  of  cold,  and  what  he  described  as  a  "dragging." 
lie  ulVu  frit  nausea,  but  never  actually  vomited.  On  examination  of  the 
ejiiL'astrium  there  was  seen  an  indentation  of  considerable  depth,  and  deepest 
in  the  middle,  which  he  said  was  caused  by  the  wooden  instrument  used  in 
bootmaking,  at  which  he  had  worked  "  all  his  life."  The  part  was  painful  on 
II.-  ireneral  health  did  not  seem  much  broken,  and  the  specific 
gravity  of  the  urine  was  1.0'JO.  With  rest,  Nitrate  of  Bismuth,  and  Iron,  he 
lost  his  symptoms,  and  was  discharged  from  care  June  21st. 

But  of  course  it  was  to  be  expected  that  his  symptoms  would 

return ;  for  these  men  spend  fourteen  hours  a  day  with  their 

heads  bent  down  close  to  their  knees,  pressing  a  hard  stick  into 

-tomach;  and  the  injury  which  was  once  done  could  not 

but  be  aggravated  by  time. 

The  final  blow  to  the  stomach  given  by  this  trade  is  exempli- 
fied in  this  next  case. 

CASE  LXXIV. — James  P — ,  a  shoemaker,  aged  37,  was  admitted  to  St. 
Mary's,  May  4th,  1860.  He  said  he  had  never  been  well  since  he  was  one-and- 
twi'nty.  His  bowels  were  never  moved  of  their  own  accord,  he  occasionally 
vomited,  and  he  had  a  perpetual  pain  in  the  right  side  of  the  epigastrium, 
winch  he  called  his  "liver."  He  continued  in  this  state  till  1855,  when,  as  he 
was  vomiting,  there  came  up  a  sudden  gush  of  blood.  Since  then  the  same 
thing  had  happened  five  times,  the  last  time  the  night  before  admission.  He 
did  not  throw  up  any  blood  when  in  the  ward,  but  his  statement  was  confirmed 
by  the  passage  of  a  considerable  quantity,  liquid  and  clotted,  from  the  bowels. 
A.  date  of  Lead  stopped  the  hemorrhage,  and  by  dint  of  complete  rest  and 
Pepsine  he  was  able  to  take  the  ordinary  diet  of  meat  and  vegetables,  with 
the  addition  of  a  pint  of  beef  tea  at  dinner,  for  a  week  before  he  went  out  on 
tin-  'J.")th,  taking  Quinine  three  times  a  day. 

The  rapid,  though  probably  only  temporary,  relief  of  the  pain 
in  the  epigastrium  and  the  regained  power  of  taking  food,  shows 
how  mueh  might  be  done  in  these  cases  by  rationally  removing 
the  original  cause  of  the  complaint.  No  greater  blessing  to  the 
artisan  was  ever  invented  than  tin-  rpriuht  Shoemaker's  Table, 
introduced  by  Mr.  Sparkes  Hall  to  the  trade.  At  it  the  work- 
man stands  or  sits  on  a  high  stool  at  will,  holding  his  work 
i  by  a  strap  and  stirrup  regulated  by  the  foot.  Thus  all 
pressure  OIL  the  epigastrium  is  avoided,  and  Mr.  Hall  tells  me 
that  many  of  his  most  skilled  hands  who  used  to  be  oiV  work 


110  HABITS    LEADING    TO    INDIGESTION. 

from  illness  nearly  half  their  time,  and  driven  to  drink  to  drown 
pain  the  rest,  can  now  earn  daily  wages,  and  are  become  tempe- 
rate rich  men. 

The  difficulty  lies  in  the  change  of  method — by  no  means  a 
light  difficulty.  A  visit  to  the  Egyptian  room  at  the  British 
Museum  shows  that  shoemakers  have  worked  in  a  doubled-up 
posture  at  least  since  the  days  of  the  Pharaohs,  and  we  cannot 
expect  them  to  alter  in  a  moment  what  certainly  has  some  con- 
veniences. Moreover  all  do  not  suffer.  A  stomach  in  a  perfectly 
robust  condition  probably  can  resist  even  this  daily  compression. 
But  when  occasionally  it  is  joined  to  fusty  cold  workshops,  long 
abstinence,  tippling,  accidental  illness  of  any  kind,  then  it  tells 
chronically,  and  the  injured  part  is  unable  to  recover  itself. 
The  dura  ilia  make  a  bad  use  of  their  blessings  by  deterring 
the  weaker  vessel  from  the  trouble  of  learning  a  new  method, 
and  are  aided  by  the  lazy  conservatism  natural  to  the  ignorant. 
Still  I  think  it  is  our  bounden  duty  to  advise  all  shoemakers  we 
come  across  as  patients  to  adopt  the  upright  bench,  and  perhaps 
in  time-  we  may  succeed. 

I  have  not  found  this  evil  of  compressed  stomach  from  the 
constrained  posture  of  tailors.  They  generally  suffer  from 
drinking  and  bad  ventilation. 

SECTION   VI. 
Sexual  excesses. 

I  alluded  in  the  last  paragraph  of  the  fourth  section  to  a 
perversion  of  the  sexual  instinct  to  be  found  sometimes  accom- 
panying indigestion.  I  have  seen  it  named  as  a  cause,  indeed 
it  is  so  named  by  M.  Chomel  in  the  work  I  quoted.  My  expe- 
rience does  not  enable  me  to  agree  in  this,  though  I  cannot  deny 
the  possibility  of  it.  Still  I  believe  that  more  searching  inquiry 
into  those  cases  where  the  two  morbid  phenomena  are  associated 
together,  will  often  enable  us  to  discover  a  different  sequence, 
and  to  call  the  quasi-voluntary  act  of  lust  an  effect  of  feelings 
perverted  by  disease.  A  perfectly  healthy  lad  never  invents 
this  for  himself;  and  if  he  has  taken  it  up  from  imitation,  curi- 
osity, or  the  suggestions  of  infamous  pornographic  literature, 
disgust  and  boyish  honor  soon  break  him  of  it.  Where  it  is 


HABITS    LEADING    TO    INDIGESTION".  Ill 

continued  there  is  almost  always  some  mental  or  bodily  disease 
requiring  medical  care.     As  for  example: — 

CASK  I.X  X  V.-  Augustus  T — ,  aged  24,  came  to  me  in  October,  1863,  say- 
ing  that  for  some  years  till  lately  he  had  been  in  the  habit  of  solitary  lust, 
and  that  he  was  suffering  from  excessive  flatulence,  and  from  pain  produced 
at  the  epigastrium  by  any  quantity  of  food  sufficient  to  nourish  the  body.  I  !•• 
hat)  broken  himself  of  the  habit,  but  was  dreadfully  distressed  in  mind  at  the 
degradation  of  ever  having  indulged  in  it,  and  attributed  to  it  the  low  state 
of  bodily  health  lie  endured.  But  I  found  on  inquiry  that  from  childhood  he 
had  been  a  greedy  boy,  morose  and  weakly,  that  he  had  suffered  from  worms ; 
and  that  his  education  was  neglected  on  account  of  his  health,  long  before 
the  nasty  practice  he  told  me  of  had  been  adopted. 

On  the  other  hand,  I  can  remember  in  my  notes  records  of  at 
two  cases  where  the  obscenity  had  been  learnt  by  imitation 
and  practised  as  often  on  the  average  as  twice  daily  for  a  sue- 
on  of  years  without  the  alimentary  canal  suffering  at  all, 
whatever  other  functions  may  have  failed. 

The  natural  sexual  excess  is  also  said  by  French  writers  to 
produce  indigestion.  I  do  not  happen  ever  to  have  seen  an 
instance.  The  digestion  of  prostitutes  (whose  trade  may  be 
considered  an  excess)  has  always  seemed  to  me  exceptionally 
good.  Their  health  is  less  injured  by  riotous  living  and  spirit- 
drinking  than  that  of  other  people  who  equally  indulge.  I  speak 
of  the  class  who  are  patients  at  the  Lock  Hospital,  where  I  have 
been  the  physician  for  some  years. 

SECTION    VII. 
Solitude. 

Eating  in  a  dull  heavy  kind  of  way  without  enjoying  it  often 
produces  dyspepsia  in  a  moderate  form. 

I .  \  X  V  I. — Rev.  N.  R — ,  a  bachelor  of  middle  age,  was  my  patient  in 
the  autumn  of  lsr.4.  for  flatulence  of  bowels  accompanied  by  confusion  of  in- 

i  during  the  second  stage  of  digestion,  and  sleeplessness.  By  regula- 
tion ..f  the  diet,  and  (Quinine  with  Strychnine,  he  got  well  at  that  time.  In 
N"\( -iiiln T.  l"t'.."i.  he  (  nine  to  me  again,  saying  that  when  he  dined  in  company 

'ild  digest  anything,  and  never  sull'ered.  however  rash  he  had  been  at 
table.  I5ut  when  he  took  hi.-  meals  alone  for  several  days  together,  his  old 
symptoms  of  the  previous  year  returned,  and  no  carefulness  or  abstemiousness 
prevented  them. 


112  HABITS    LEADING    TO    INDIGESTION. 

I  should  conjecture  the  pathological  condition  to  be  a  partial 
paralysis  of  the  solar  plexus,  from  attention  being  directed  to  it. 

Several  commercial  and  literary  men  have  complained  to 
me  of  attacks  of  vomiting  (that  is,  temporary  paralysis  of  the 
stomach1)  when  they  took  dinner  alone,  and  so  were  apt  to  let 
the  mind  dwell  deeply  on  some  interesting  subject;  and  they 
have  told  me  in  wonder  that  they  could  dine  out  and  eat  and 
drink  all  sorts  of  rich  things  with  impunity.  They  did  not  seem 
aware  of  the  preservative  value  of  frivolous  conversation. 

CASE  LXXVII. — A  famous  scientific  man  of  middle  age,  deeply  occupied 
with  his  pursuits,  and  never  in  the  habit  of  "wasting  his  time,"  as  he  called  it, 
on  amusement  of  any  kind,  complained  to  me  that  when  he  dined  alone,  as  he 
usually  did  on  the  plainest  food,  he  invariably  vomited  afterwards.  But  that 
in  dining  out  he  never  suffered  even  from  nausea.  At  one  time  he  used  to 
read  at  meals,  but  that  seemed  to  make  no  difference  at  all. 

Which  is  waste  of  time,  work  or  play  ?  Truly  sometimes  one 
and  sometimes  the  other,  but  each  out  of  their  due  season,  and 
proportion.  The  epithet  "frivolous"  (from  the  same  root  as 
"  frio"  =  what  may  be  easily  rubbed  out  and  forgotten)  is  not 
necessarily  depreciatory.  Light  thoughts,  light  occupations  that 
are  easily  rubbed  out  and  leave  no  care  or  impression  behind 
them,  are  good  for  mind  and  body  and  worldly  estate. 

SECTION   VIII. 
Intellectual  exertion. 

The  overuse  of  the  mind  sometimes  induces  indigestion  in 
those  previously  not  very  strong. 

CASE  LXXVIII. — Rev.  G.  B — ,  aged  50,  after  being  invalided  home  from 
India,  got  well  enough  to  take  the  post  of  secretary  to  a  society.  But  the 
brain-fag  consequent  upon  that,  without  any  other  change  of  his  habits, 
brought  on  nocturnal  flatulence,  nightmare,  and  seminal  emissions.  And 
during  the  day  his  spirits  were  so  depressed  that  existence  was  a  burden. 
This  was  in  November,  1862,  and  a  month  afterwards  he  came  to  report  that 
assistance  in  his  work  had  been  granted  him,  and  that  he  was  quite  set  to 
rights,  except  a  little  weight  at  the  epigastrium. 

It  is  to  be  observed  that  what  I  am  speaking  of  here  is  not 
the  original  condition  of  mind  which  was  described  as  a  cause 

1  See  chapter  on  Vomiting,  in  a  later  part  of  the  volume. 


HABITS    LEADING    TO    INDIGESTION.  113 

of  the  in<li_M>tion  of  starchy  food  especially,  in  the  last  chapter 
XIV.  &c.),  but  rather  the  wrong  mode  of  using  it. 
Unavoidable  evils  were  then  described,  TOO  consequences  of 
which  might  be  alleviated,  hut  the  causes  were  either  past  or 
irremediable.  In  this  chapter  I  am  tracing  the  complaints  to 
habits  which  are  voluntarily  taken  up,  and  can  be  laid  down  at 
will. 

I  do  not  believe  it  is  the  quantity,  so  much  as  the  quality  of 
intellectual  occupation  which  does  harm.  Composition,  the 
tion  of  thoughts,  even  the  putting  of  old  thoughts  into  new 
forms,  is  not,  in  my  experience,  injurious.  Where  it  is  enjoyed, 
I  believe  it  a  peculiarly  healthy  occupation.  It  is  the  dreary 
routine  work,  invito  genio  and  against  time,  which  knocks  up  a 
man's  stomach. 

In  reality  I  believe  the  last  two  cases  are  exceptional,  and 
that  you  will  more  commonly  find  some  other  cause  at  work  in 
those  who  accuse  intellectual  occupation.  For  example: — 

CASK  I. XX  IX. — Joseph  W — ,  an  engineer  past  middle  age,  with  the  broad 
forehead,  square  jaw,  and  shrewd  eye  of  a  mind  like  the  iron  he  bent  to  his 
will,  came  to  me  in  Man  li.  lst;3,  complaining  of  flatulence,  with  spasmodic 
pain  in  the  epigastrium,  and  that  he  was  quite  knocked  up  by  the  toil  of 
invention,  to  which  he  attributed  his  bodily  illness.  On  inquiry  I  found  that 
In'  had  ticri)  stimulating  thought  by  champagne  luncheons,  and  that  it  was 
after  these  he  felt  distress. 

SECTION  IX. 

Want  of  Employment. 

The  concentration  of  the  mind  upon  itself  we  are  assured  by 

psychologists  will  produce  mental  disease.     I  confess  myself 

that  1   have  some  doubts  whether  we  ought   not  rather  to  say 

that  it  makes  evident  and  brings  into  prominence  previously 

•  •ause  the  same  class  of  observers  generally 

also  go  on  to  say  that  the  fixing  of  the  mind  oh  any  portion  of 
the  body  will  cause  morbid  phenomena  to  be  therein  developed. 
Now  this  is  an  experiment  I  have  often  amused  mvse-lf  by  Irving 
in  a  leisure  hour;  I  have  looked  at,  thought  about,  argued  about, 
and  in  imagination  di.-sei-ted.  my  finger  tips,  nose,  toes,  epi 
trium,  kn«">.  ,v-..  till  the  power  of  attention  was  wearied  out; 
8 


114  HABITS    LEADING    TO    IXDIGESTIOX. 

but  no  pain,  or  redness,  or  throbbing,  or  swelling,  no  stiffness, 
or  coldness,  or  anaesthesia,  has  followed.  What  really  happens 
however  in  consequence  of  a  concentration  of  the  mind  upon  the 
body  is  this — should  there  be  already  existing  any  slight  morbid 
condition  capable  of  declaring  itself  to  the  nervous  system,  but 
not  in  such  a  way  as  to  draw  off  from  other  objects  the  engaged 
mind;  then,  should  the  attention  be  unfortunately  attracted  to 
this  part,  the  pain  is  noticed,  is  in  idea  multiplied  and  exagge- 
rated. Anxiety  and  distress  follow  attention,  and  then  at  last 
the  bodily  functions  are  interfered  with  (for  these  passions,  as 
has  been  illustrated  in  the  second  chapter,  lower  the  powers  and 
secretions  of  the  digestive  canal),  the  saliva  and  gastric  juice 
fail,  and  the  digestion  suffers.  From  thence  perhaps,  as  a  tertiary 
effect,  may  ensue  deteriorated  nutrition  of  the  local  injury. 

CASE  LXXX. — An  old  blind  soldier,  who  lived  near  the  Chelsea  Dispensary 
when  I  was  physician  there,  used  constantly  for  several  years  to  come  to  me 
from  time  to  time  complaining  of  excruciating  pain  in  the  abdomen.  He  had 
his  pension,  and  was  comfortably  off  in  circumstances.  No  one  on  looking  at 
him  could  doubt  the  reality  of  his  feelings ;  yet  there  was  never  anything  in 
his  state  of  health  apparent  to  account  for  them.  The  only  cause  I  could 
trace  them  to  was  his  being  occasionally  left  alone  by  his  wife  and  family ; 
and  then  his  blindness  prevented  his  mind  being  drawn  off  to  surrounding 
objects,  and  he  would  sit  still,  allowing  any  little  abdominal  discomfort  to  be 
depicted  in  exaggerated  colors  on  his  vacant  fancy.  He  had  in  truth  always 
a  little  flatulence,  but  never  the  "  excruciating  pains,"  except  on  these  occa- 
sions. 

I  have  not  seen  much  of  blind  people,  but  such  as  come  under 
my  notice  are  always  disposed  to  exaggerate  in  this  way  any 
slight  bodily  discomforts  into  real  tortures.  From  want  of 
mental  distraction,  their  internal  sensations  occupy  too  promi- 
nent a  place  in  their  psychical  life. 

Just  in  the  same  way  people  who  voluntarily  deprive  their 
minds  of  occupation,  find  out  the  existence  of  innumerable  pains 
in  various  parts  of  their  bodies ;  the  anxiety  and  worry  thus 
occasioned  really  does  deprive  them  of  sleep,  injures  their  diges- 
tion, and  by  the  time  they  are  driven  to  the  doctor  makes  them 
materially  as  well  as  mentally  ill.  Sometimes  these  pains  arise 
from  actual  organic  change  which  had  existed  for  many  years 
unnoticed,  and  therefore  without  effect  on  the  general  health, 


11  AH  ITS    LEADING    TO    INDIGESTION. 

and  unaffected  l>y  it.  But  when  once  it  is  thought  about  so  as 
to  create  anxiety,  it  feels  the  innutrition  hence  arising,  and 
grows  rapidly  \v- 

I.X  X  XI. — A  paper-maker,  utterly  uneducated,  though  very  wealthy, 

TH.  \\-as  brought  to  me  by  his  wife  ami  doctor  in  March,  1861.     He  had 

had  a  slight  catarrh  of  the  bladder,  following  an  old  stricture,  many  years  ; 

-  long  as  he  was  iu  business  he  never  suffered  materially  from  it.    Having 
more  money  than  he  could  possibly  want,  he  thought  he  would  retire 

and  "  enjoy  himself."     I'.ut  alas,  he  had  nothing  to  enjoy  himself  with,  except, 

';.  his  money,  which  is  not  of  much  use  without  tastes  to  spend  it  upon. 

look  to  thinking  about  his  health,  considered  what  was  wholesome  and 

what  not,  what  to  eat,  drink,  and  avoid,  for  the  sake  of  his  defective  urinary 

.     Tin-  coiisiMjiu'iice  was  that  his  digestion   failed,  he  complained  of 

•  after  food,  vertigo,  flatulence,  and  "  intolerable"  pain  in  the  epigastrium. 
•peet,  as  he  sat  rubhinjr  the  pit  of  his  stomach  when  introduced  to  me, 

was  one  of  abject  misery.  The  urine  contained  a  little  pus,  but  he  made  no 
complaint  about  his  bladder.  He  had  the  white  tongue  of  a  nervous  man, 
and  his  bowels  were  costive.  My  next  report  of  him  is  dated  August,  1  >(',•_>. 
when  I  saw  him  in  much  the  same  unhappy  state  of  feeling.  But  the  bladder 
had  trot  a  good  deal  worse ;  there  was  more  pus  and  albumen  in  the  urine,  and 
the  specific  gravity  was  only  1.015.  I  do  not  detail  the  treatment,  for  it  was 
various  and  useless  ;  and  a  few  weeks  after  his  last  visit  I  received  a  card  from 
the  family  announcing  his  funeral. 

As  a  more  cheering  illustration  per  contra,  I  will  choose  an 

nee  of  the  same  anatomical  condition  as  the  last,  in  order 

>\v  that  urinary  disease  is  not  necessarily  depressing  to  the 

mind. 

I A  X  X  1 1. — J.  B — ,  a  confidential  clerk  at  the  India  House,  getting  on 
for  60  years  of  age,  was  sent  to  me  by  Mr.  Coulson  in  June,  185G.  lie  had 
enlar-  •  and  vesical  catarrh,  but  managed  to  avoid  all  serious  incon- 

venience in  that  quarter  by  using  a  catheter.     Now  and  then  his  stomach  got 
out  of  order,  but  he  could  jjeuerally  trace  that  to  a  good  dinner  or  soin 
social  imprudence;  and  then  his  bladder  discharged  more  pus.     So  he  went 
on  some  years,  till  I  began  to  observe  he  was  coming  to  me  rather  mot 
i|iiently.  and  that  he  had  a  care-cumbered  face,  leading  me  to  ask  him  u  hat  lie 
had  been  doing  lately.      "I  \. -thing.     I  am  a  gentleman  at  la  rue  now — 

•ned  off."  1'oor  Charles  Lamb  \  also  an  India  Ilou.-e  clerk,  I  thought  of 
him  and  his  humorous  pathos  «<>  being  pensioned  off.  and  said  immediatc-lv 
that  it  would  never  answer,  it  was  poison  to  mind  and  body.  ••  Ah.  there's  a 
good  deal  in  win  :  as  the  spring  comes  on  I  and  Mrs.  15.  will  take  to 

gardening  :  she  has  a  family  taste  that  way.      And  !••  gardening  they  took,  and 
I  saw  him  much  seldomer.  and  heard  no  complaints  of  his  vesical  trou 
though  he  dropped  in  at  the  end  of  1  •-('.-!  to  introduce  a  patient  to  me,  and  see 


116  HABITS    LEADING    TO    INDIGESTIOX. 

how  I  was.  I  trust  they  still  continue  to  plant  their  cabbages  and  bud  their 
roses,  and  to  make  wierd  skeleton  bouquets  of  dissected  leaves  for  their  friends, 
and  to  be  as  happy  and  as  little  ashamed  as  Adam  and  Eve  in  Milton. 

Those  in  whom  tastes  have  been  implanted  for  simple  amuse- 
ments cannot  be  too  grateful  for  them.  And  I  hold  it  one  of 
the  wisest  things  we  can  do  in  busy  middle  age  to  keep  up  or 
acquire  such  tastes.  When  once  the  inevitable  pensioning  off 
comes,  it  is  usually  too  late  to  go  through  the  necessary  educa- 
tion. I  have  indeed  seen  a  diplomatist,  who  had  held  in  his 
grasp  the  destiny  of  nations,  commencing  at  sixty-five  the  study 
of  Italian,  for  the  sake  of  reading  Dante ;  and  I  thought  at  the 
time  it  showed  more  courage  even  than  his  old  trade  of  bullying 
into  reason  the  masters  of  armies.  Such  courage  is  rare,  and 
more  generally  the  mind's  mirror  gets  dimmer  and  dimmer,  till 
there  arrives  with  premature  haste  the  state  of  things  so  graphi- 
cally painted  in  the  last  chapter  of  Ecclesiastes.  I  am  sorry  to 
say  the  stock  example  of  this  is  a  member  of  our  own  profession, 
Sir  Astley  Cooper,  who,  when  in  retirement  satiated  with  wealth 
and  honors,  is  described  as  looking  over  the  trees  of  his  park 
with  a  conviction  that  some  day  he  should  hang  himself  from 
one  of  them.  He  had  wasted  his  life  in  routine  work,  and  it 
was  too  late  to  educate  the  mind  to  anything  else. 

The  class  of  patients  instanced  in  the  last  two  cases  are  such 
as  have  some  structural  disease,  of  which  I  have  described  the 
aggravation  by  idleness  acting  through  the  digestive  organs. 
More  common  still  are  those  who  have  no  existing  organic 
change  in  any  part  of  the  body ;  and  in  these  the  digestive 
organs  act  upon  themselves  only,  and  produce  distress  and 
functional  derangement.  A  state  of  things  arises  pithily 
sketched  by  Dr.  Markham  in  a  letter  introducing  a  patient  to 
me  a  few  months  ago — "  he  formerly  was  poor,  worked  hard, 
had  plenty  of  appetite,  little  dinner,  and  little  time  to  eat  it ; 
now  he  is  rich,  with  lots  of  time  and  dinner,  but  no  stomach." 

Sometimes  the  vacancy  of  mind  left  by  the  surrender  of  in- 
voluntary occupation  is  such  that  absolute  mental  aberration 
is  the  result.  There  are  actual  delusions  about  facts,  persua- 
sions that  they  have  happened  when  in  reality  they  have  not. 
Under  those  circumstances  diagnosis  is  much  impeded  by  the 


HABITS    LEADING    TO    INDIGESTION.  117 

difficulty  of  knowing  what  is  true  and  what  is  false  of  the 
various  >y  n  q  it  i  MILS  related  to  you,  if  they  are  not  in  themselves 
til-void  of  internal  probability. 

In  the-''  cases  I  have  been  much  assisted  by  the  observation 
of  a  peculiarity  in  the  mental  state  of  the  half-insane,  which 
isplayed  in  the  following:  — 

I  .  \  X  X  1  1  1.—  M  r.  <  J—  ,  aged  53,  was  till  the  early  part  of  last  year  en- 
i  in  active  business.  He  then  gave  up  his  occupation,  and  supposed  he 
luul  sufficient  mental  resources  to  pass  life  agreeably.  So  he  settled  at  a 
fa.-hionable  watering-place,  and  took  to  desultory  art  and  literature.  But 
tin-  i-li'Lr:uicies  of  life  sit  oddly  upon  him,  for  he  is  a  grim-featured  harsh-man- 
nt.Ti.-il  man,  unlikely  to  find  much  favor  in  that  society  whose  business  is 


!!<•  had  the  aspect  of  strength  and  health,  but  complained  when  I  saw  him 
that  he  had  1  n-en  for  several  weeks  a  dreadful  sufferer  from  excruciating  pains 
in  the  abdomen  coming  on  at  night  and  entirely  preventing  rest.  I  had  no 
reason  for  doubts,  till  I  observed  a  painful  anxiety,  which  increased  as  he 
talked,  that  I  should  believe  him,  joined  to  an  evident  suspicion  that  I  did  not 
do  so.  I  however  pn-scribed  him  some  Valerian  at  night. 

When  I  saw  him  again  in  a  week  the  Valerian  had  evidently  made  him 
f<  vt-ri^h.  and  he  said  the  nocturnal  pains  were  worse  than  ever.  I  then 
eliritod  that  last  autumn,  in  fact  after  he  had  been  trying  idleness  for  some 
months  only,  he  had  been  exceedingly  low-spirited,  and  that  he  used  to  get 
nervous  and  fidgety  at  niifht  and  have  paroxysms  of  causeless  terror. 

I  huve  since  seen  reason  to  conclude  that  the  pains  by  night  and  the  wake- 
fulness  were  purely  imaginary. 

I  have  always  in  my  lectures  on  the  practice  of  medicine  in- 
1  much  «MI  the  aid  to  the  diagnosis  of  mental  disease 
ail'onled  by  the  peculiar  suspiciousness  of  itself  which  the 
mind  exhibits.  I  remember  a  lady  coming  into  my  study 
saying,  "  I  am  n»t  one  of  your  nervous  patients"  —  the  exordium 
alVonled  me  immediate  evidence  that  she  was  so,  as  the  result 
l>r«ived.  All  lunatics,  even  in  their  wildest  mood,  seem  to  me 
to  recogni/e  a  difference  between  their  delusions  and  facts,  and 
this  inakt-s  them  often  so  furiously  to  insist  upon  them.  I. 
talk  ami  shallow  faith  always  run  together.  This  is  still  more 
remarkable  in  the  halt-insane:  at  an  early  stage  of  insanity. 
r  on,  namely  in  the  halt-insane  stage  of  recovery,  the 
;  .  :iar  suspiri"  much  less  marked  :  indeed  an  amiable 

t  rust  t'u  1  ness  often  takes  its  placf.      With   the  earlier  stage- 
non-specialists  are  most  concern.  -d,  and   1  am  sure  what  1  have 
named  is  a  valuable  aid  to  di. 


118  HABITS    LEADING    TO    INDIGESTION". 

The  peculiarity  is  rarely,  or  only  cursorily,  alluded  to  in  mono- 
graphs on  insanity,  for  the  simple  reason  that  specialists  do  not 
experience  the  difficulty,  and  therefore  do  not  value  any  means 
of  overcoming  it.  Nobody  is  brought  to  an  asylum  without 
there  being  abundant  evidence  of  mental  aberration,  and  the 
slighter  indications  therefore  are  of  no  practical  moment.  Our 
patients  are  probably  never  in  a  state  to  render  restraint  legal, 
or  desirable  on  any  account,  remain  useful  and  unnoticed  mem- 
bers of  society  all  their  lives,  and  perhaps  only  manifest  a  delu-- 
sion  in  intercourse  with  their  physician.  We  hail,  therefore, 
with  gratitude  any  thread  to  guide  us  out  of  the  dilemma 
between  a  fact  and  a  fancy. 

It  is  not  absolutely  necessary  to  have  been  a  hard  worker  first 
for  idleness  to  lead  the  thoughts  inwards  to  the  digestion,  and 
put  it  out  of  order.  Some  who  have  been  Lotus-eaters  all  their 
lives,  still  do  not  get  acclimatized. 

CASE  LXXXIY. — Miss  M.  J — ,  aged  about  fifty-five,  has  as  tough  a  con- 
stitution as  most  people  I  know  of,  and  had  consulted  me  about  catarrhs  or 
some  trifling  ailments  occasionally.  When  I  was  away  from  England  in  1>65. 
she  took  a  whim  to  go  and  live  at  an  hydropathic  establishment.  She  was  not 
hydropathized,  and  it  is  a  pity  she  was  not,  for  it  would  perhaps  have  kept 
her  out  of  mischief.  But  she  used  to  listen  to  the  inmates  talking  about  their 
insides,  and  having  very  limited  mental  though  plenty  of  pecuniary  resources, 
she  had  nothing  else  to  think  of.  The  consequence  was  she  began  to  suffer 
from  gastralgia,  even  after  the  excellent  wholesome  diet  and  fine  air  she  was 
getting  at  the  place ;  and  when  she  came  to  London  to  consult  me  on  my 
return  she  was  seriously  out  of  health,  always  feeling  a  weight  at  the  epigas- 
trium after  meals,  having  acid  eructations  and  sometimes  vomiting,  and  the 
tongue  appearing  pale  and  coated.  I  made  her  leave  the  noxious  moral 
atmosphere,  and  adopt  the  physically  worse  alternative  of  close  London  lodg- 
ings with  their  well-known  greasy  cookery.  Then  she  engaged  a  companion 
of  her  own  age  and  position  to  talk  to.  and  aided  by  some  Quinine  and  Strych- 
nine soon  got  well  enough  to  run  over  for  a  trip  abroad,  with  a  strict  caution 
to  keep  clear  of  spas  and  invalids. 

My  main  object  in  this  section  has  been  to  save  these  poor 
sufferers  from  drugs,  which  confirm  their  ailments. 


HABITS    LEADING    TO    INDIGESTION.  119 

SECTION  X. 

Ab'ise  of  Purgatives. 

There  is  no  habit  so  pernicious  to  the  gastric  digestion  as 
inatieally  taking  purgative  drugs.    And  there  is  none  more 
common. 

It  is  commenced  sometimes  from  mere  caprice  and  imitation. 

I  .X  X  X  V. — I  saw  last  week  a  fine  tall  girl  of  seventeen  at  home  for  a 
few  days  I'runi  M-ln><>l.  Her  mother  untieing  how  pale  and  listless  she  was, 
inquired  into  her  daily  doings,  and  got  out  a  confession  that  nearly  all  the 
scholars  were  addicted  to  drenching  themselves  with  pills;  this  made  them 
thirsty,  and  they  tupped  up  with  another  purgative,  "Lemon  Kali"  (an  adulte- 
Uitartrate  of  I'otash)  several  times  a  day.  As  ray  young  friend  had 
never  taken  physic  in  her  life,  except  a  few  homoeopathic  globules  at  a  former 
sehuul.  and  some  conventional  draught?  during  the  measles,  this  discipline 
made  her  ill :  and  it  opened  my  eyes  to  the  ease  with  which  bad  habits  may 
be  acquired.  Kven  in  her  case  it  had  begun  to  produce  a  sensitiveness  to  the 
:ice  of  anything  iu  the  excretory  viscera,  which  very  quickly  grows  in 
intensity,  and  renders  the  abstinence  from  purgatives  soon  a  positive  depriva- 
tion. (.<!>'•  ml»r,  18GG.) 

Tt  is  the  increase  of  sensitiveness  which  does  the  harm ;  for 

shortly  this  sensitiveness,  commencing  probably  in  the  intes- 

-  to  the  stomach,  and  the  presence  of  food  there 

3  pain  and  cannot  be  borne,  for  the  time  requisite  to  normal 

4ion.     The  food  being  undigested,  costiveness  results ;  an 

ased  demand  for  purgatives  is  made;  sometimes  even  a 

medical  man  is  induced  to  order  them  or  to  sanction  them,  and 

the  difficulty  of  breaking  the  habit  becomes  really  formidable. 

;d  even  a  homoeopathic  physician,  who  placed  his  dan 
under  my  care,  had  been  persuaded  to  allow  the  growth  in  her 
of  this  living  on  poison. 

The  ill-health  induced  by  purgatives  is  all  the  more  serious 
in  that  it  affects  the  most  important  classes  of  aliments.     In 
XLV  an  illustration  is  given   of  the  indigestion  of  fat,  in 
LV  of  the  iii  i  of  meat  arising  from  this  cause. 

There  is  usually  givat  difficulty  in  eliciting  evidence  of  pur- 
re  habits;  all  the  more  so  the  higher  in  rank  and  more 
•ated  the  victim<  ar  and  then  a  sensible  country 

girl  will   make  a  confession  which  puts  .to  shame  her  more  re- 

liiu   |  ; — 


120  HABITS    LEADING    TO    INDIGESTION". 

CASE  LXXXVI. — Emma  W — ,  aged  25,  a  well-built  strong  country-woman, 
had  to  come  to  London  in  the  summer  of  1851  as  a  nurse  to  the  children  of 
an  old  friend  of  mine.  Since  then  she  had  suffered  from  pain  in  the  epigas- 
trium (originally  excited  by  tight  lacing),  waterbrash  and  debility.  Her 
tongue  and  face  were  getting  anaemic.  For  some  months  her  fellow-servants 
and  mistress  had  been  dosing  her  with  purgatives.  She  said  she  certainly 
did  feel  lighter  after  she  took  them,  but  in  spite  of  that  she  had  sense  to 
remark  that  she  was  getting  worse  and  worse,  and  could  not  but  attribute 
it  to  the  drugs.  Yet  she  fancied  she  could  not  do  without  them,  and 
feared  she  should  be  obliged  to  leave  London  and  her  comfortable  place. 
This  was  on  December  4th  that  she  was  sent  to  me.  Before  the  end  of  the 
month,  by  simply  leaving  off  purgatives  gradually,  and  taking  a  little  Iron, 
she  lost  her  gastralgia  and  other  stomach  symptoms,  gained  strength  and 
spirits,  and  remained  in  London  many  years  a  valuable  servant,  till  the  junior 
branches  of  the  family  left  the  nursery. 

In  the  above  case  it  is  mentioned  that  purgatives  were  left 
off  "  gradually ;"  this  I  usually  accomplish  by  giving  moderate 
doses  of  Aloes  and  Myrrh  in  pill,  and  with  each  change  of  pre- 
scription increasing  the  proportion  of  Myrrh  and  diminishing 
that  of  Aloes,  then  dividing  the  pill  into  two,  and  at  last  omit- 
ting it  altogether.  Another  expedient  is  to  recommend  small 
cold-water  enemata  which  are  not  really  purgative  at  all,  and 
allow  the  bowels  to  act  spontaneously,  at  the  same  time  as  they 
cool  the  rectum  and  take  off  any  feeling  of  congestion  and 
tenesmus,  acting  in  fact  as  a  sort  of  shower-bath. 

I  have  known  the  continued  use  of  purgatives  kept  up  by  a 
medical  practitioner  with  a  vain  hope  of  making  the  fecal 
evacuations  of  his  patient  more  healthy  in  aspect. 

CASE  LXXXYII. — I  was  summoned  in  April,  1861,  some  distance  into 
the  country  to  see  a  young  married  woman,  whom  I  found  confined  to  bed 
with  hysterical  paralysis  of  the  lower  extremities  and  occasional  vomiting. 
As  my  coming  had  been  debated  and  arranged  some  days,  I  found  prepared 
for  my  reception  a  long  row  of  vessels,  set  in  order  of  time,  containing  what 
had  passed  from  the  bowels.  Each  one  was  more  unnatural,  more  fetid,  more 
ragged,  and  with  more  undigested  matter  in  it  than  the  former.  The  medical 
attendant  had  been  purging  vigorously,  and  intended  to  go  on  purging  vigor, 
ously,  in  spite  of  the  obstinacy  with  which  the  patient  got  worse.  When  the 
gray  powder,  &c.,  was  exchanged  for  beef-tea  enemata,  milk,  mutton  chops, 
and  Pepsine,  a  rapid  improvement  followed.  In  subsequent  letters  I  heard 
no  more  of  foul  stools. 

There  is  a  very  curious  superstition  about  the  use  of  mercu- 
rials. They  are  supposed  to  make  the  alvine  excretion  normal, 


HABITS    LEADING    TO    INDIGESTION.  121 

though  the  only  visible  result  is  its  becoming  more  abnormal 
with  cadi  dose.  They  are  supposed  to  do  good  by  "acting  on 
tin'  liv.T."  whether  the  liver  is  acting  too  little  or  too  much. 
Tln-v  are  supposed  to  "act  on  the  liver,"  though  it  has  been 
slmwn  by  Dr.  Scott's  experiments'  that  the  quantity  of  bile  is 
not  increased,  nav,  is  rather  diminished  when  Mercury  is  taken. 
All  that  the  metal  can  be  really  seen  to  effect  on  the  hepatic 
function  is  a  poisoning  of  the  bile,  so  as  to  prevent  absorption 
by  the  ilia,  and  to  cause  the  secretion  to  be  rejected  in  a  liquid 
form  per  amun  :  ami  tliat  is  a  very  doubtful  advantage  to  most 
invalids. 

The  only  effect  at  all  desirable  following  mercurial  purgation, 
and  which  in  fact  seems  to  constitute  for  patients  the  attraction 
,  is  the  relief  of  certain  cerebral  symptoms, *giddiness, 
must-re  volitantes,  dark  globes  in  the  sight,  singing  in  the  ears, 
&c.,  which  result  from  excess  of  venous  over  arterial  blood  in 
the  brain.  It  acts  in  this  case  as  a  destructive  upon  the  venous 
blood,  and  adjusts  the  balance' by  subtraction.  Time  after  time 
as  the  rough  expedient  is  resorted  to,  the  strength  is  lessened 
by  it,  and  the  necessity  for  its  use  appears  greater  more  and 
more  subtraction  is  required.  The  good  and  true  way  of  re- 
storing the  circulation  to  its  normal  conditions  is  by  addition, 
by  increasing  the  supply  of  new-made  blood  to  the  arteri 

SECTION   XI. 

Abuse  of  Alcohol. 

The  immediate  effect  of  diluted  alcohol  on  mucous  membranes 
is  first  to  dry  them  by  staying  the  aqueous  exhalation,  and 
shortly  to  dump  tl't-m  with  an  abnormal  formation  of  rauci 

•illary  circulation,  and  to  deaden  the  sensibility  of 
the  nerves.  The  last  action  is  its  use.  Where  there  is  risk  to 
health  from  undue  sen.-itivrn.-ss.  alcohol  in  moderation  is  an  in- 
valuable remedy.  It  may  be  considered  as  an  antidote  to  the 
condition  discussed  in  tli<  tion;  and  if  a  man  were  con- 

demned to  take  unm-ressary  purgatives,  ho  could  not  do  !>• 
for  his  stomach  than  counteract  part  of  their  evil  eiVect  l>y  mix- 
ing them  with  alcohol.     Kxperirnce  >  have  led   to  the 

1  Beale's  "Archives,"  vol.  i.  p.  209. 


122  HABITS    LEADING    TO    INDIGESTION. 

same  conclusion  as  science,  and  we  find  the  most  popular  drench- 
ing recipes  have  either  alcohol  or  some  equivalent  anaesthetic 
in  their  composition.  It  is  equally  antidotal  where  the  sensi- 
tiveness is  the  manifestation  of  weakness  in  the  nervous  system, 
either  from  exhaustion  or  imperfection.  And  thus  it  becomes 
the  daily  food  or  daily  physic  (I  care  not  which  it  is  called) 
of  those  whose  daily  life  brings  their  nerves  into  this  state. 

To  the  health  of  the  bulk  of  mankind  the  habitual  moderate 
use  of  alcohol  is  probably  quite  indifferent.  One  day  they 
may  want  a  little,  and  therefore  be  the  better  for  it ;  another 
day  they  would  be  in  a  more  perfect  condition  without  it.  So 
a  balance  is  struck  by  the  habitual  users ;  and  their  chief  argu- 
ment in  favor  of  fermented  liquids  remains  the  unanswerable 
one  that  they  are  nice.  No  mean  argument  either,  for  it  weighed 
with  our  Divine  Master,  when  He  first  showed  His  power  by 
treating  the  merry-makers  of  Cana  to  better  wine  than  they 
were  accustomed  to. 

The  effects  of  habitual  excess  (which  in  some  people  is 
taking  any  alcohol  at  all,  in  others  is  taking  what  is  universally 
allowed  to  be  "to  much")  is  on  the  gastric  area  very  similar  to 
that  of  any  other  anaesthetic.  A  partial  paralysis  of  it  is  in- 
duced, it  ceases  more  and  more  to  perform  its  peculiar  functions 
for  the  owner ;  "  he  cannot  eat  but  little  meat,  his  stomach  is 
not  good,"  though  he  may  still  digest  vegetables  and  feel  a  re- 
lief from  filling  the  void  with  them. 

If  the  appetite  for  food  remains  large,  the  weakened  walls  of 
the  receptacle  are  liable  to  yield  to  the  dilatation,  as  in  the  fol- 
lowing instance. 

CASE  LXXXYIII. — Mr.  F ,  a  burly  farmer  of  middle  age,  came  to  me 

in  December,  1856,  complaining  of  a  constant  sinking  at  the  epigastrium, 
relieved  indeed  for  a  short  time  by  taking  food,  and  partially  by  a  glass  of 
spirits.  He  ate,  however,  without  appetite,  and  did  not  even  enjoy  his 
brandy,  for  it  had  become  a  mere  matter  of  supposed  necessity  with  him. 
Latterly  animal  food  caused  disgust  and  nausea,  his  bowels,  from  being  cos- 
tive, had  become  relaxed,  with  yeasty  fermenting  stools,  and  he  had  got  very 
down-hearted  about  himself.  The  condition  had,  however,  been  coming  on 
very  gradually  he  knew  not  how  many  years,  and  he  was  without  difficulty 
brought  to  see  the  connection  it  had  with  a  habit  of  taking  spirits  between 
meals. 

The  tongue  was  coated  with  patches,  showing  sharp  defined  edges,  of  epi- 


TTABITS    LEADING    TO    INDIGESTION.  123 

t helium  on  a  bright  red  base.  It  was  described  as  being  more  generally  all 
red,  like  a  beefsteak.  Tin-  nmpanitie  iv«;onan--e  on  percussion  of  the  stomach 
extended  right  up  into  the  c:irdi:ie  region  and  down  nearly  to  the  navel,  and 
laterally  in  proportion;  and  the  abdomen  was  prominent  as  well  from  accu- 
mulation of  tat  in  the  omenttim  and  parietes. 

1  put  him  on  a  1'anting  diet,  with  at  first  some  liquor  potassje  to  dee; 

:-pulei)ee.  and  1  ordered  fifteen  grains  of  Boudalt's   IVpsine  powder  to 

n  with  animal  food  to  assist  in  its  digestion.     I  persuaded  him  also  to 

promise  that  no  spirituous  liquor  should  be  taken  between  meals;  but  he 

said  he  had  sooner  die  than  surrender  a  glass  of  brandy-and-water  at  supper. 

I  must  confess  I  had  some  doubts  about  the  observance  of  the  promise. 
Yet  1  was  wrong;  he  did  leave  off  spirits,  and  he  did  get  much  better  and 
more  active  in  business,  and  continued  so  for  nearly  two  years.  Then  some 
temptation  arose,  he  resumed  his  old  habits,  and  was  brought  up  again  to 
London  in  1858,  in  the  same  state  as  before.  The  same  advice  was  given, 
but  I  have  no  record  of  the  result. 

Persons  with  dilated  stomachs  are  very  apt  to  become  obese, 
though  the  flesh  digested  is  not  sufficient  to  sustain  the  muscular 
strength.  And  this  sort  of  obesity  is  very  difficult  to  manage, 
from  the  impediment  which  the  muscular  weakness  offers  to 
taking  exercise. 

In  women,  perhaps,  from  the  bondage  of  the  dress,  the  stomach 
does  not  in  my  experience  become  dilated  from  the  paralyzed 
condition  induced  l»y  alcohol.  The  following  case  represents 
the  more  common  injury  done  to  the  viscus. 

I A  XX  IX.-  Mrs.  P — f  aged  33,  came  under  my  care  October  3d. 

She    lived    in  the  country  in  easy  circumstances,  had  no  family  or 

.   to  attend  to.  and  had  become  lazy,  fat,  flatulent,  and  low-spirited.' 

For  several  years  she  had  been  gradually  getting  into  the  habit  of  alleviating 
her  uncomforta'-  'ions  by  small  doses  of  brandy,  which  she  took 

morning,  noon,  and  night,  but  never  in  such  a  quantity  as  to  get  into  her 
head.  The  rea-oii  of  her  coming  to  me  was  the  inability,  which  was  growing 
upon  her,  of  keeping  the  smallest  quantity  of  food  upon  her  stomach.  It 
was  vomited  almost  immediately.  She  was  very  hysterical,  and  the  catamenia 
\va-;  irregular.  Leaving  off  brandy  and  taking  some  Valerian  and  shower- 
baths  stayed  the  vomiting;  but  two  months  afterwards  I  was  obliged  to  go 
abroad,  and  lost  sight  of  her. 

The  sudden   leaving  <>fV  excess  of  stimulants  will   in  clderly 
>ns  sDiiietiriifs  cause  disturbed  cardiac  action,  even  when 
vmptums  an-  relieved  by  it. 

Mr-.  15—.  an  elderly  lady  habitually  rather  short-winded,  came 
tor,  1864,     Si.    •  ring  from  loss  of  appetite, 


124  HABITS    LEADING    TO    INDIGESTION. 

with  frequent  nausea  and  vomiting,  which  I  attributed  to  a  habit  recently 
acquired  of  taking  brandy  between  meals.  The  pulse  was  then  regular.  I 
urged  her  to  give  up  the  dangerous  habit  forthwith,  and  saw  her  again  on  the 
2d  of  November.  The  nausea  and  vomiting  had  ceased,  and  she  felt  some 
return  of  appetite.  But  she  had  a  new  sensation  of  sinking  at  the  epigas- 
trium, and  was  shorter  of  breath.  On  examination  of  the  pulse  I  found  it 
irregular  and  intermittent.  The  heart-sounds  were  normal.  I  gave  her  some 
Valerian,  and  on  the  18th  found  her  still  bravely  resisting  the  temptation  to 
brandy,  and  dismissed  her  with  a  prescription  for  some  Quinine  and  Strych- 
nine. 

I  am  used  to  quote  to  such  patients  as  the  last  in  terrorem  an 
experience  I  once  had  of  want  of  resolution  in  breaking  off 
dram-drinking — an  experience  happily  rare,  and  not  cited  here 
as  illustrative  of  a  class,  but  still  instructive  as  an  extreme 
warning. 

CASE  XOI. — In  September,  1857,  I  was  called  by  Dr.  Jephson  to  a  con- 
sultation in  the  case  of  an  unfortunate  middle-aged  woman,  who  was  dying 
prostrated  by  uninterrupted  vomiting.  It  is  needless  to  detail  the  symptoms, 
which  were  those  of  simply  retching  and  sinking,  and  the  nature  of  the  case 
was  made  apparent  by  her  desiring  her  maid  to  bring  her  a  glass  of  brandy 
even  while  I  was  speaking  to  her.  Our  attempts  to  feed  her  with  beef-tea 
enemata  and  Opium  were  unavailing,  and  she  died  next  morning. 

She  told  me  the  habit  had  been  acquired  only  the  previous  year,  while  staying 
with  some  friends  in  Scotland  at  their  shootings,  where  a  nip  of  whiskey  was 
the  regular  preparative  for  breakfast. 

But  dram-drinking  is  by  no  means  confined  to  uneducated 
persons,  those  whose  "talk  is  of  bullocks,"  or  to  idle  women. 
I  am  ashamed  to  say  I  have  been  consulted  about  its  conse- 
quences by  several  members  of  our  own  profession,  who  ought 
to  know  better  and  set  a  better  example.  Quis  custodiet  ipsos 
custodes?  They  tell  me  the  temptation  is  very  great  in  country 
practice,  sitting  in  tedious  conclave  in  lone  farmhouses  during  a 
lingering  labor,  or  watching  some  long-dying  patient  with  no 
person  that  can  understand  your  thoughts  within  many  miles. 
There  is  nothing  else  to  do  but  drink ;  and  then  the  next  day 
you  have  to  be  at  work  at  the  usual  early  hour,  and  the  work 
can  hardly  be  done  without  a  hair  of  the  dog  that  bit  you. 

The  last  sentence,  expressing  the  necessity  for  staving  off 
alcoholic  reaction,  reminds  me  to  mention  a  test  which  I  am 
used  to  apply  to  discover  whether  the  amount  of  alcohol  taken 
is  such  as  really  to  injure  the  stomach.  I  ask  whether  the 


HABITS    LEADING    TO    INDIGESTION.  125 

:it  over  is  in  the  habit  of  taking  it  in  the  forenoon.  If  so, 
1  at  once  feel  sure  t  hat  the  stomach  has  suffered.  When  a  con- 
siderable interval  intervenes  between  the  indulgences,  and  the 
reaction  is  allowed  to  have  its  way  till  ordinary  digestion  is 

•red,  the  constitution  may  very  often  be  still  uninjured. 
But  I  have  not  yet  met  with  a  forenoon  tippler,  even  though 
In-  never  got  drunk  in  his  life,  without  a  condition  of  stomach 
which  most  infallibly  shortened  his  days.  I  find  it  a  great 
advantage  in  the  selection  of  lives  for  insurance  to  substitute  a 
poiir-  'ion  on  this  head  for  the  usual  aimless  inquiry 

whether  the  proposer  is  "sober  and  temperate."  Nobody  is 
anything  else,  of  course;  and  the  answer  is  a  mere  declaration 
of  opinion.  But  "do  you  take  spirits  in  the  forenoon?  Is 
that  a  habit?"  require  categorical  statements  of  facts,  which  if 
wilfully  false  would  vitiate  the  policy. 

The  way  in  which  life  is  shortened  by  this  stomach  affection 

Jierally  secondarily  through  the  liver,  originating  anaemia 
and  ascites :  sometimes  through  the  pancreas ;  when  the  ema- 
oiated  Lrin-drinker,  such  as  Hogarth  drew,  is  produced.  More 
rarely  the  kidneys  break  down,  and  Bright's  disease  arises.  In 

ilie  nearer,  physiologically  speaking,  the  organ  to  the 
stomach  the  more  likely  it  is  to  suffer. 

When  a  patient  is  persuaded  to  give  up  dram-drinking,  he 
often  has  such  a  dreadful  depression  of  spirits  that  his  resolution 
is  apt  to  pive  way,  though  he  is  convinced  he  is  acting  right. 
And  sometimes  he  may  have  a  kind  of  delirium  tremens  from 
the  sudden  shock,  before  he  can  get  into  the  temperate  habit  of 
taking  stimulants  only  at  dinner,  or  of  giving  them  up  alto- 
gether, according  to  the  nature  of  the  case.  Still  it  is  best  to 

ce  the  absolute  rule  of  no  alcohol  between  meals,  and  to 
supply  its  place  temporarily  by  an  Kther  and  Ammonia  draught, 
then  by  Ammonia,  either  alone  or  with  a  bitter,  and  then  to 
stop  it  altogether. 

BBCTIOH    XII. 
Tobacco. 

The  more  usual   toxical  of  the  alkaloids  absorbable 

from  the  Tobacco  plant  are  exemplified  in  the  following  typical 


126  HABITS    LEADING    TO    INDIGESTION". 

CASE  XCII. — Smoking. — Five  years  ago  a  young  married  man  of  about  32 
rushed  to  me  in  a  great  state  of  alarm,  stating  that  he  had  suddenly  become 
impotent.  This  was  not  strictly  true,  but  still  he  certainly  was  less  fit  for 
matrimonial  privileges  than  was  right  in  a  husband  of  two  years'  standing. 
The  next  complaint  he  made  was  of  cardiac  palpitation  (on  examination  I 
found  the  heart  beating  unevenly  and  irregularly),  of  frequent  cold  sweats, 
nervous  agitation  and  causeless  fears  by  night  and  day  too. 

I  found  he  had  recently  returned  from  sheep-farming  in  Australia  for  several 
years.  When  there  he  used  to  smoke  strong  Shag  in  a  short  cutty-pipe  all 
day  and  almost  all  night.  He  had  brought  his  dear  though  dirty  companion 
with  him  to  London,  and  continued  the  habit  with  a  certain  amount  of  modi- 
fication. In  the  fresh  air  of  the  wild  downs  he  had  never  suffered  the  slightest 
illness,  but  no  sooner  had  he  been  in  London  a  few  weeks  than  the  symptoms 
detailed  had  come  upon  him,  and  had  gradually  increased. 

He  could  not  at  first  understand  why  I  should  attribute  them  to  the  Tobacco, 
why  it  should  be  so  bad  for  him  in  England,  when  abroad  it  seemed  to  pre- 
serve his  health.  But  at  last  becoming  convinced  of  the  difference  between 
British  and  Australian  air,  he  drew  his  little  black  pet  from  his  pocket  and 
broke  it  in  my  fire-place.  He  would  never  smoke  again,  rather  than  risk  de- 
priving his  wife  of  her  just  claims  on  his  attention. 

I  took  the  tide  at  the  turn  and  clenched  the  promise,  which  was  certainly 
kept  long  enough  for  the  palpitations,  nervous  fears,  &c.,  to  be  cured  without 
physic. 

CASE  XGIII.— Snuffing.— October  22d,  1866.  Eev.  C.  W— ,  a  country 
clergyman  of  literary  and  sedentary  habits,  has  usually  enjoyed  good  health, 
and  in  spite  of  a  fondness  for  his  study  and  dislike  of  parochial  work,  visits 
in  his  district,  and  has  regularly  done  two  full  services  every  Sunday.  It  is 
a  difficulty  in  properly  performing  the  last-named  duty  which  brings  him  to 
me.  For  several  months  he  has  noticed  that  his  manner  in  the  pulpit  has 
been  getting  awkward,  and  he  feels  hurried  and  has  an  unreasonable  desire 
to  get  to  the  end  of  what  he  is  about.  He  sometimes  cannot  help  skipping 
over  the  latter  half  of  a  sentence  so  as  to  go  on  with  the  next.  For  some 
weeks  this  hurry  of  manner  has  been  extending  itself  to  his  social  and  pro- 
fessional intercourse  on  week-days,  and  to-day  in  speaking  to  me  he  is  exces- 
sively precipitate  and  nervous.  He  can  scarce  keep  his  hands  still,  and 
clutches  at  and  handles  all  the  little  things  around  him  in  my  study,  though 
evidently  ashamed  of  his  solecism  in  demeanor. 

His  appetite  is  good,  he  has  no  flatulence,  he  can  eat  anything  he  likes, 
and  drink  a  bottle  of  port  without  feeling  any  inconvenience,  in  short  he  is 
evidently  unaware  of  having  digestive  organs.  The  actions  of  the  bowels 
and  kidney  are  quite  healthy,  but  he  evacuates  the  bladder  more  frequently 
than  is  needful. 

On  inquiry  I  find  he  is  a  devoted  snuffer,  having  his  pocket  box  filled  up 
every  day,  and  keeping  a  second  relay  ou  his  table  as  well. 

I  said  at  once  I  would  not  prescribe  for  him  unless  he  would  make  at  once 
at  least  a  step  towards  giving  up  this  habit.  He  readily  consented  to  keep 


HABITS    LEADING    TO    INDIGESTION.  127 

a  box  only  on  his  table,  and  to  have  it  filled  only  twice  a  week.  To  supply 
temporarily  its  place,  1  allowed  him  two  teaspoonfuls  of  Tincture  of  Valerian 
twice  a  <: 

w  him  again  in  a  week  much  improved,  and  in  a  fortnight  after  that  he 
••I  <|iiite  to  have  regained  his  natural  dignified  manner  and  to  be  recon- 
ciled in  abandon  his  snuff-taking. 

These  histories  give  a  pretty  full  detail  of  all  the  important 

mieiKi  usually  produced  by  excess  of  Tobacco,  according 

\I>erience.     Others  are  merely  a  repetition  of  these,  in 

which   it   may  be  observed  that  the  digestive  organs  seem  re- 

markaMy  free  from  injury.     In  fact  the  only  two  cases  I  can 

iinil    iu    my  note-books   where   the   alimentary   viscera   have 

suffered  are  the  following. 

XCIV.— Mr.  William  T — ,  aged  apparently  about  50,  came  to  me  iu 

March.  l>f>6,  complaining  of  costiveness,  pain  in  epigastrium  about  three 

hours  after  food,  flatulence,  and  dryness  of  mouth.     I  could  not  find  any  <!••- 

viation  from  wholesome  habits  of  life  except  that  he  smoked  a  great  deal  of 

„'  Tobacco.     And  the  event  proved  that  to  be  the  source  of  his  dyspep- 

r  by  re.-tricting  himself  to  one  cigar  after  breakfast,  and  taking  some 

Charcoal  and  Soda,  he  came  to  me  towards  the  end  of  the  month  much 

better. 

\'.— H.  C— ,  a  country  surgeon,  aged  45,  complained  last  year  to 
me  that  he  was  really  becoming  unable  to  follow  his  profession  from  e 

•.atulence  in  the  ilia.  When  lie  was  talking  to  a  patient  the  bowels 
would  begin  rumbling  and  rolling  so  that  he  felt  ashamed  to  stay  in  the  room. 
"''  "  -cveral  times  a  day  to  unbutton  and  lie  with  his  abdomen  up 

in  the  air.  .\t  night  sleep  was  broken,  and  sometimes  rendered  impossiMe 
by  the  same  nuisance.  Curiously  enough,  when  he  sat  up  all  night,  say  with 
a  troiil.lesoine  midwifery  patient,  he  was  not  half  so  bad.  While  talking  with 
me.  1  observed  he  took  snuff  several  times,  and  on  inquiry  found  he  consumed 
nearly  an  ounce  daily.  He,  of  course,  could  not  I.e  unaware  of  the  cause  of 
hi.-  disease,  but  absolutely  refused  to  give  it  up.  He  said  life  wuuld  not  be 
ithout  it. 

In  all  other  instances  which  I  have  taken,  notes  of,  drinking 
was  join. •,!  with  smoking  <>r  snail'-taking  as  the  deeided  efficient 
i-au.-i!  of  indigestion,  so  that  t  pTOTfl  nothing  tor  .M.-U-H- 

titie  purpo,(.s:   ,,:•  XVIII.  f,.r  example)  the 

-howii  to  be  a  libel    l>v  the 

symptoms  not  ceasing  when  the  alleged  cause  had  been  long 
reiiK- 

1  l!  I  am  surpri.-.  iveral  medical  wri1  u  to 

consider  it  a   matter   of  course  that   the  pleasures  oi'  the  pipe 


128  HABITS    LEADING    TO    INDIGESTION. 

should  have  a  special  deleterious  effect  on  the  salivary  glands 
and  stomach. 

Dr.  Prout  says,  "  The  severe  and  peculiar  dyspeptic  symp- 
toms sometimes  produced  by  inveterate  snuff-taking  are  well 
known ;" — so  well  apparently,  that  he  does  not  enumerate 
them,  so  that  perhaps  he  may  mean  the  nervous  weakness 
described  above — but  then  he  goes  on  to  remark,  "I  have 
more  than  once  seen  such  cases  terminate  fatally  with  malig- 
nant disease  of  the  stomach  and  liver."1  The  insinuation  is  that 
Tobacco  causes  malignant  disease ;  which  is  proved  false  by  the 
fact  of  cancer  of  all  the  organs  being  more  common  among 
women  than  among  men ;  and  among  men  being  quite  as 
common  among  those  who  do  not  smoke  as  among  those  who 
do.  It  is  very  clear  that  Dr.  Prout  has  misapprehended  the 
pains  of  incipient  cancer,  and  ascribed  them  to  the  Tobacco 
which  was  taken  to  solace  them. 

I  must  allow  that  I  myself  took  such  ideas  as  Dr.  Prout's 
for  granted,  and  supposed  that  of  course  the  salivary  and  gas- 
tric secretions  must  be  the  chief  sufferers  from  Tobacco,  till  I 
came  to  review  my  experience  and  drew  out  these  two  solitary 
specimens  of  their  being  possibly  affected  by  it.  They,  there- 
fore, must  not  be  considered  as  the  type  of  a  class. 

The  poison  of  Tobacco  smoke  seems  to  attack  more  particu- 
larly the  nervous  system.  Intermittent  pulse,  palpitation  of 
the  heart,  shaky  hands,  nervousness,  imaginary  impotence,  and 
the  like,  are  produced  by  it,  but  not  primary  affections  of  the 
digestive  organs,  as  a  rule.  And  in  snuffing  the  large  quan- 
tity of  the  drug  which  goes  down  the  oesophagus  seems  to  pass 
the  mucous  membrane  with  little  injury,  and  to  affect  the 
system  only  by  the  absorption  of  its  alkaloids  soluble  in  the 
blood. 

This  last  sentence  may  afford  a  hint  as  to  the  method  of 
treating  our  patients.  It  is  avowedly,  almost  proverbially,  diffi- 
cult to  get  them  to  resign  the  soothing  herb.  Few  of  them 
take  such  a  wholesome  alarm  as  Case  XCII,  or,  if  they  did, 
would  not  act  upon  it.  They  say  the  sudden  deprivation  is  too 
much  for  their  strength  of  mind.  Now  if  a  Tobacco  is  pre- 

1  "  Stomach  and  Urinary  Diseases,"  page  25. 


HABITS    LEADING    TO    INDIGESTION.  129 

1  by  abstracting  the  main  deleterious  agent,  Nicotina,  a  step 
•  by  which  the  patient  may  be  let  down  easy,  and  not  run 
the  risk  of  an  abrupt  change.  For  smokers  a  convenience  of 
this  sort  is  afforded  by  the  Vevay  or  other  Swiss  cigars,  which 
are  the  common  leaf  fitted  for  use  in  cigars  by  soaking  in 
water  till  one-third  of  its  substance  is  abstracted. 

I  do  not  know  of  any  kind  of  snuff  manufactured  on  a  similar 
plan,  and  consequently  there  is  not  the  same  aid  to  persuading 
a  victim  to  surrender  the  indulgence ;  but  one  old  snuffer  told 
me  he  had  broken  himself  of  it  by  the  aid  of  kitchen  salt  finely 
pounded,  of  which  he  mixed  more  and  more  daily  with  the 
contents  of  his  box,  till  it  was  nearly  all  salt.  Then  he  took 
plain  salt,  and  soon  gave  that  up.  I  have  heard  also  of  ginger 
j  employed  in  the  same  manner.  Another,  who  had  ac- 
quired the  habit  at  Cambridge  many  years  ago,  and  did  not 
like  the  look  of  it  on  leaving  the  University,  used  to  carry  for 
some  time  a  vinaigrette  of  Aromatic  Vinegar  for  the  same  pur- 
pose. 

SECTION  XIII. 
Tea. 

The  following  case,  illustrative  of  the  pernicious  consequences 
of  excessive  tea-drinking,  is  extracted  from  my  Clinical  Lectures 
at  St.  Mary's  Hospital. 

\ « '  V  1 . — M  aria  D — ,  a  spinster  of  thirty-two  by  her  own  confession, 
but  probably  older,  has  been  a  general  servant  in  a  light  place  for  seven 
years.  She  has  been  happy,  and  has  enjoyed  pretty  good  health,  interrupted 
only  by  occasional  h>  :  but  for  some  time  lately  things  have  seemed 

to  ;muoy  her  more  than  they  ought  to  do.  Three  months  ago,  she  had  a  bad 
'•bilious"  headache,  which  was  followed  by  Rome  paroxysms  of  laughing  and 
i-ryiiiL'.  Five  wn-ks  l>:n-k  she  had  an  attack  of  diarrluea.  from  which  she 
got  better,  ami  wrnt  to  work  again  in  spite  <>f  weakness,  for  she  was  loath  to 
IK  h«-r  mistress  want  her.  But  exertion  was  in  vain,  for  she  no  sooner  tried 
to  clean  a  grate  than  she  fell  down  speechless,  and  had  a  succession  of  hys- 
terical tit>,  losing  her  senses,  but  not  biting  her  tongue.  Then  she  began 
vomiting  everything  >he  t.mk.  and  this  had  l»ei-n  going  on  for  three  weeks, 
and  seemed  to  amount  to  ;i  complete  rejection  of  all  her  food  immediately  it 
was  swallowed.  When  you  saw  her.  there  was  excessive  flatulence,  the  air 
bursting  up  from  the  stomach  in  roaring  eructations  while  one  was  talking  to 
her. 

In  this  woman,  the  effect  of  the  wide  pupil  and  sympathetic  hemipt. 

9 


130  HABITS    LEADING-    TO    INDIGESTION. 

not  hidden  even  by  the  disfigurement  of  blear  edges  to  the  eyelids;  and  it 
quite  accords  with  the  droll  earnestness  of  her  manner,  which  increases 
gradually  as  you  let  her  go  on  talking  about  herself,  leaving  no  doubt  of  her 
strong  hysterical  diathesis. 

As  to  cause,  that  is  still  more  directly  traceable  to  the  stomach  than  even 
in  the  last  case.1  It  would  seem  that  for  some  years  she  has  been  becoming 
more  and  more  addicted  to  tea-drinking.  She  confesses  to  caring  for  little 
else,  so  long  as  she  could  get  her  favorite  food  or  physic — or  poison — I  do  not 
know  exactly  how  to  call  it.  Her  mistress  was  quite  angry  with  her  for  eat- 
ing so  little  meat ;  and  with  a  far-sighted  economy  not  common  in  her  class 
of  life,  took  much  trouble  to  keep  up  the  health  of  a  faithful  servant.  But 
the  weakened  stomach  refused  meat,  and  she  was  literally  starving  in  the 
midst  of  abundance.  (Nov.  1,  1861.) 

Much,  ill-health  arises  among  women  of  the  lower  orders  in 
this  country  from  the  custom  of  sluicing  themselves  with  tea. 
(I  am  not  aware  if  similar  results  follow  in  Holland  and  Portu- 
gal, the  only  other  tea-drinking  populations  in  Europe.)  Want 
of  appetite  for  the  quantity  of  coarse  albuminous  food  neces- 
sary to  working  people  is  induced.  In  the  upper  ranks  not  so 
much  harm  is  done  by  the  five  o'clock  kettle-drums  and  similar 
sloppy  proceedings  now  so  common,  because  their  bill  of  fare 
is  more  attractive  to  the  palate,  and  they  usually  get  as  much 
flesh  food  as  is  good  for  them  in  spite  of  it.  Besides  which, 
educated  persons  have  usually  the  instinct  to  stop  in  time  a 
custom  which  really  depends  on  a  mere  whim.  Still  it  cannot 
under  any  circumstances  be  a  wholesome  habit. 

Tea  seems  more  injurious  to  the  stomach  in  the  usual  form  of 
infusion  than  otherwise.  I  remember  some  years  ago  being 
puzzled  in  viewing  lives  for  insurance  by  some  singularly 
colored  tongues  which  I  saw  in  those  who  came  before  me. 
On  inquiry,  I  found  their  occupation  was  "tea-tasting"  for  the 
greater  part  of  the  day.  Now,  tasting  tea  is  performed  partly  by 
sipping  some  of  the  infusion,  but  principally  by  sniffing  up  the 
aroma  into  the  nostrils  and  chewing  a  few  leaves  in  the  mouth. 
I  was  given  to  understand  that  they  sometimes  found  themselves 
nervous  after  a  long  day's  work,  that  possibly  the  hand  might 
shake  a  little  in  those  who  worked  too  hard,  and  that  the  tongue 
acquired  this  curious  smooth  orange-tinged  coating,  but  that 
the  digestion  and  appetite  did  not  suffer  from  the  trade. 

1  A  very  similar  case  not  necessary  to  be  repeated  in  this  connection. 


HABITS    LEADING    TO    INDIGESTION.  13,1 

SECTION    XIV. 
>Wl. 

An  occasional  effect  of  the  Salts  of  Opium  on  the  stomach  is 
exhibited  in  the  following  case  : — 

Xt'VII. — Jane  B — ,  a  domestic  servant,  thirty-seven  years  of  age, 
was  under  ray  care  at  St.  Mary's  for  some  painful  tumors  of  the  abdomen 
affecting  the  uterus  and  bladder,  in  March,  1861.  On  account  of  the  pain, 
she  was  ordered  a  grain  of  Acetate  of  Morphia  every  night  She  had  never 
isly  hud  any  narcotics.  She  only  took  one  dose,  for  that  was  followed 
by  vomiting,  very  severe  during  the  night,  and  recurring  at  intervals  during 
the  next  four  days. 

The  possibility  of  an  idiosyncrasy  of  this  sort  is  no  reason  for 
shrinking  from  the  essay  of  a  good  and  useful  medicine,  but  it 
well  to  know  that  it  may  occur. 

The  more  chronic  effects  upon  the  organ  are  shown  in  the 

next : — 

VIII. — August  12th,  1853. — George  N — ,  an  assistant-surgeon^ 
aged  35,  states  that  for  eight  years  he  has  been  in  the  habit  of  taking  large 
quantities  of  Opium.  He  began  the  practice  in  the  first  instance  to  prevent 

ling  the  want  of  food,  when,  as  a  surgeon's  assistant,  he  was  obliged  to 

wait  many  consecutive  hours  without  anything  to  eat.     He  at  first  confined 

!l  tn  twenty  drops  of  Laudanum  a  day;  but  he  gradually  increased  the 

amount  till  he  finished  a  fiuidounce  of  Laudanum  daily,  and  quarter  of  an 

of  crude  Opium  in  addition  weekly.  He  tried  several  times  to  leave  it 
off.  but  was  prevented  \\\  the  nausea  and  pain  in  the  epigastrium  which  he 
experienced.  He  had  lost  much  flesh,  and  got  miserably  weak  ;  but  he  pro- 
bably would  have  gone  on  with  his  poison  had  he  not  been  frightened  by  a 
numbness  and  partial  paralysis  of  the  left  arm,  and  a  loss  of  memory,  which 
made  him  think  he  was  going  to  have  a  stroke,  and  caused  him  to  put  himself 
under  my  care. 

I  immediately  restricted  him  to  one  grain  of  Opium  at  night,  and  conse- 
quently found  him  next  day  in  miserable  pliirht.  vomiting,  with  pain  in  the 
epigastrium,  and  with  a  most  melancholy  aspect.  I  gave  him  strong  beef-tea 
uud  port  wine.  Imt  got  afraid  next  day  that  he  would  slip  through  my  fingers, 
and  so  I  added  some  Chloroform  draughts.  These  relieved  the  sickness.  I'.y 
the  17th  he  begun  to  get  better,  and  the  Chloroform  could  then  be  omitted. 
On  the  20th  he  felt  very  sinking  for  the  want  of  it,  but  yet  fancied  he  was  re- 
covering his  appetite.  He  had,  at  his  own  request,  a  mutton  chop  and  half 
ti  pint  of  porter.  On  the  2 lid  In-  remarked  his  memory  was  improved,  and  ho 
iri't  up  and  dressed.  Then  his  bowels  got  irregular,  and  following  that  lead  I 
.  ic.t  the  quantity  of  Opium  to  what  he  had  in  some  Chalk  and 


132  HABITS    LEADING    TO    INDIGESTION. 

Opium  powders,  ordered  to  be  taken  when  there  was  diarrhoea.    By  Septem- 
ber 1st  he  was  able  to  leave  it  off  entirely  and  take  care  of  himself. 

It  appears  from  this  to  be  the  digestion  of  meat  and  fat  which 
is  mainly  impeded  bj  Opium.  It  requires,  however,  to  be  taken 
in  great  excess  for  the  effect  to  be  produced. 

And  even  then  the  result  is  not  by  any  means  immediate. 
That  is  shown  by  the  case  quoted ;  and  I  remember  also,  in 
1838  or  9,  a  sweeper  of  a  lucrative  crossing  coming  to  swear  an 
affidavit  before  my  father  as  a  magistrate  that  the  bearer  of  the 
said  affidavit  was  in  the  habit  of  using  two  drachms  of  solid 
Opium  daily.  The  reason  of  this  measure  was  that  the  shop 
where  he  was  accustomed  to  deal  for  the  drug  had  changed 
hands,  and  the  new-comers  refused  to  serve  him  with  such  a 
dangerous  quantity.  He  was  nigh  crazy  with  the  restriction, 
but  armed  with  his  legal  document  he  felt  safe  for  the  future, 
and  I  used  to  see  him  at  his  post  many  years  afterwards. 

On  the  whole,  Opium-eating  does  less  harm  than  is  generally 
supposed — very  often  much  less  harm  than  the  pains  which  it  is 
taken  to  counteract.  The  great  objection  to  it  seems  to  be  the 
difficulty  of  leaving  it  off,  when,  as  in  the  case  of  the  surgeon's 
assistant,  it  had  from  its  monstrous  excess  begun  to  tell  on  the 
health.  But  this  difficulty  has  been  very  much  exaggerated,  as 
well  as  the  temporary  pleasures  of  indulgence,  from  the  descrip- 
tion having  fallen  into  the  hands  of  the  imaginative  De  Quincey 
— a  man  whose  world  was  in  himself,  and  whose  whole  biogra- 
phy, when  published,  let  us  into  the  secret  of  "  The  English 
Opium-eater"  being  really  a  work  of  fancy.  The  same  may  be 
said  of  Coleridge's  "Recollections."  I  find  in  my  notes  a  special 
memorandum  of  the  scorn  with  which  the  difficulty  was  treated 
by  a  genuine  strong-minded  man. 

CASE  XCIX. — During  the  year  1859  I  saw  from  time  to  time,  for  some 
trifling  ailments  of  which  I  have  no  accurate  record,  Captain  B — ,  a  fine, 
hearty,  God-fearing  sailor  of  the  old  school,  seventy-two  years  of  age.  He 
told  me  that  twice  in  his  life  he  had  been  a  decided  Opium-eater,  taking  as 
much  as  a  drachm  in  solid  form  daily.  I  expressed  my  surprise  at  his  having 
given  up  to  the  practice,  which  surprise  he  did  not  at  all  understand,  saying, 
"  Why,  I  should  be  ashamed  of  both  my  philosophy  and  my  religion,  and  turn 
sceptic,  if  either  singly  would  not  strengthen  me  with  resolution  enough  for 
that.'1  The  occasion  for  which  he  took  the  Opium,  some  trying  mental  cir- 


HABITS    LEADING    TO    INDIGESTION.  133 

ciimstancos.  having  passed  away,  he  diminished  the  quantity  by  five  grains 
daily  till  he  ceased  entirely  ;  and  I  must  say  his  constitution  appeared  none 
the  worse.  I  hear  from  his  daughter  he  is  still  alive  and  well  at  80. 


Opium  is  given  medicinally,  that  is  for  the  relief  of 
certain  bodily  or  mental  pains,  and  when  it  succeeds  in  relieving 
those  pains,  it  does  not  seem  to  produce  its  special  toxical 
\vhere  it  is  really  wanted  it  rarely  does  harm.  For 
instance,  in  inflammation  of  the  serous  membranes,  as  pericar- 
ditis, I  have  given  to  young  persons  who  never  took  it  before 
i  rli  as  three  grains  every  three  hours,  without  producing 
constipation  or  over-sleepiness  till  such  time  as  the  inflamma- 
tion had  subsided.  (See  "Lectures  chiefly  Clinical,"  Lect.  XV, 
"  On  Pericarditis.")  Of  course  I  did  not  arrive  at  this  quantity 
all  at  once,  but  began  with  a  grain  or  a  grain  and  a  half,  and 
increased  rapidly. 

I  have  myself  taken  Opium  for  the  relief  of  various  incon- 
veniences arising  from  an  amputated  limb,  but  I  have  never  felt 
the  slightest  temptation  to  continue  its  use  beyond  the  neces- 
sary period,  or  any  inconvenience  from  leaving  it  off.  The  box 
stands  alongside  of  my  razors,  and  I  do  not  feel  one  more  dan- 
gerous than  the  other. 

It  is  only  when  taken  in  great  excess,  or  when  persisted  in, 
spite  of  \varning,  that  Opium  seems  seriously  detrimental  to  the 
digestion. 

All  the  habits  in  this  chapter  instanced  as  causes  of  indiges- 
tion are  voluntary  and  capable  of  being  changed.  The  cure, 
therefore,  of  the  indigestion  lies  first  and  foremost  in  that 
change.  It  must  be  made  a  sine  </««  non  of  the  treatment  by 
.  honest  practitioner.  In  aid  of  that  I  have  given  a  few 
hints  in  passing,  but  let  it  be  understood  that  these  expedients 
are  to  be  only  temporary  :  the  effect  is  efficiently  to  be  removed 
only  by  removing  the  ca 


134 


CHAPTEE    IV. 

ABDOMINAL   PAINS. 

SECTION  1. — Heartburn.  SECTION  2. — Acidity.  SECTION  3. — Waterbrash.  SEC- 
TION 4. — Spasms.  SECTION  5. — Gripes.  SECTION  6. — Weight.  SECTION  7. — 
Wearing  pain.  SECTION  8. — Soreness  on  pressure.  SECTION  9. — Anomalous 
pains. 

Ix  the  notes  of  cases  previously  used  in  illustration  of  my 
subject  certain  pains  or  discomforts  are  often  stated  to  have 
been  felt  in  the  epigastrium  or  its  immediate  neighborhood, 
without  their  nature  being  particularly  detailed.  Either  they 
were  not  severe  enough  to  affect  the  general  treatment,  and  so 
their  form  was  not  noticed ;  or  they  could  not  be  clearly  made 
out  from  the  patient's  words ;  or  the  record  was  incomplete  in 
this  respect,  though  full  enough  for  the  immediate  purpose  of 
its  citation. 

A  little  care  will  enable  the  observer  to  distinguish  con- 
siderable differences  in  these  pains — differences  which  often  may 
modify  our  diagnosis  of  the  anatomical  state  of  the  parts,  our 
prognosis,  and  our  treatment ;  and  I  shall  devote  this  chapter 
to  a  consideration  of  them. 

The  table  of  contents  enumerates  the  names  which  I  shall 
use  in  describing  them  in  detail.  I  prefer  these  words  to  Greek 
or  Latin  compounds  which  profess  to  include  them.  The 
artificially  built-up  terms  have,  indeed,  a  show  of  science,  but 
are  not  at  all  more  accurate  in  reality,  and  much  less  graphic 
than  those  engendered  by  daily  use. 

SECTION   I. 
Heartburn. 

Heartburn  is  a  painful  sensation,  resembling  that  produced  by 
swallowing  something  very  hot,  which  arises  at  a  certain  in- 
terval after  food  in  the  upper  part  and  towards  the  left  side  of 


ABDOMINAL    PAIN'S.  135 

the  pit  of  tin*  stomach.     It  runs  in  paroxysms  at  the  back  of  the 

i  l.one  up  the  course  of  the  oesophagus,  culminating  in  the 

pharvnx,  and  each  paroxysm  often  passes  off  with  a  feeling  as 

if  hot  smoke  had  i  into  the  mouth.     The  pain  of  pure 

tburn  is  not  caused  or  increased  by  pressure,  and  is  not 

felt  between  the  shoulders. 

Then*  is  in  heartburn  often  a  temporary  salivation,  and  the 
•;ion  from  the  glands  being  voluntarily  swallowed  some- 
relieves  (by  its  slight  alkaline  reaction,  probably)  the  dis- 
•>rt  of  the  cardia;  but  if  it  is  spat  out,  no  relief  follows. 
•   of  the  passage  of  this  augmented  secretion  into  the 
irh  will  be  shortly  described  under  the  heading  of  "  Water- 
brash,"  in  a  future  section.     Though  the  sensation  is  that  of  a 
cramp,  and  the  (.esophagus  is  a  muscular  organ,  I  do  not  think 
there  is  any  real  tonic  contraction  of  the  fibres.     There  is  no 
movement  in  the  throat,  such  as  may  be  readily  felt  on  volun- 
tarilv  gulping.     There  is  certainly  no  visible  contraction  of  the 
:  of  the  fauces.     Indeed,  when  the  sensation  gets  there,  it 
is  rather  one  of  relaxation,  as  if  smoke  escaped,  say  the  patients. 
Moreover,  if  a  little  fluid  be  swallowed,  its  passage  is  not  re- 
i  by  any  stricture.     There  appears  to  me  to  be  a  subjective 
perturbation  of  sensibility,  rather  than  of  contractility,  in  the 
milder  eases  I  call  "  heartburn."     Where  there  is  a  real  spasm, 
"  waterbrash"  is  produced,  as  I  will  explain  under  that  heading. 
Though  this  morbid  phenomenon  is  manifested  by  the  oeso- 
phagus, its  causes  do  not  lie  in  the  oesophagus.     Cancer,  ulcera- 
or  stricture  of  that  organ,  do  not  originate  it  in  the  ma- 
jority of  cases  of  these  lesions,  whereas  it  is  a  very  common 
equence  of  the  slighter  morbid  conditions  of  the  stomach. 
W<-  Miav  !•  mark  that  it  is  easier  produced  by  general  than  by 
local  states  of  th  .  and  rather  by  slight  than  by  severe 

'  ant ly  find  cancerous  tumors  and  con- 

sidernble  ulcerations.  in  the  gastric  walls  without  any  su<di 
cesopha.L'eal  svmptom  at  all ;  whereas  a  catarrh,  a  mucous  flux, 
and  more  commonly  still  simple  atony  of  the  stomach,  seldom 
;  long  without  it.  This  would  seem  to  show  that  a  certain 
amount  !1  as  a  certain  amount  of  disease,  is 

•v  to  heartburn. 
From  the  effects  which  alkalies  have  in  allaying  temporarily 


136  ABDOMINAL    PAIXS.. 

this  pain,  it  may  be  inferred  to  arise  from  the  action  of  the  acid 
contents  of  the  stomach  on  the  cardiac  and  cesophageal  nerves. 
It  is  true  the  gastric  mucous  membrane  itself  does  not  imme- 
diately suffer  from  acid ;  it  secretes  acid,1  and  bears  acid  in  con- 
tact with  its  coats  without  inconvenience.  The  gullet,  too,  will 
do  so  for  a  short  time ;  swallowing  a  mouthful  of  sour  victuals 
or  drink  gives  a  healthy  man  no  immediate  discomfort.  But 
we  may  remark  that  many  influences  which,  when  intermittent 
and  alternated  with  rest,  are  indifferent  or  even  pleasant  to  the 
sensory  nerves,  become  exquisitely  painful,  and  may  even  cause 
material  disease  of  tissue,  when  long  continued.  For  example, 
the  immersion  of  a  limb  in  water  a  few  degrees  below  the  tem- 
perature of  the  air  is  not  disagreeable,  and  may  be  borne  with 
intermission  for  any  length  of  time ;  but  it  becomes  absolute 
torture  if  persisted  in  without  an  interval  of  rest  or  reaction. 
A  moderate  degree  of  pressure,  if  continued  too  long,  will  cause 
first  pain,  then  gangrene  or  atrophy.  A  continual  dribbling  of 
feces  will  make  an  anus  sore — a  continual  running  from  the 
nose  excoriate  the  nares,  &e.,  though  we  hardly  notice  it  when 
lasting  only  an  ordinary  time.  Just  in  the  same  way  we  must 
look  for  a  quite  different  class  of  consequences  from  the  inter- 
mittent and  from  the  continued  action  of  acids  on  the  sensory 
portions  of  the  pneumogastric.  But  when  we  trace  heartburn 
to  the  impression  of  acid  on  the  cesophageal  and  cardiac  plexus, 
we  do  not  necessarily  imply  that  the  acid  (normal  and  abnormal) 
is  in  excess.  It  very  often  is  not  so ;  and  we  must  refer  the 
symptoms  to  over-sensibility,  that  is,  to  the  sensibility  of  a 
normally  insensitive  part,  which,  I  may  remark  in  passing,  is 
always  a  painful  sensibility. 

1  There  appears  no  doubt  about  gastric  juice  being  secreted  acid,  and  becoming 
neutral  only  from  mixture  with  saliva.  See  the  experiments  of  Drs.  Bidder, 
Schmidt,  Griinewaldt,  and  Schroder,  compared  in  "  Digestion  and  its  Derange- 
ments," chap,  iv,  and  "Experiments  on  Digestion,"  by  Dr.  P.  Gr.  Smith  (Phila- 
delphia, 1856).  This  last-named  renewal  of  observations  on  a  patient  with 
gastric  fistula,  formerly  servant  to  Dr. -Beaumont,  seems  to  show  conclusively' 
that  in  the  human  subject  the  acid  secreted  is  not  hydrochloric,  but  probably 
lactic.  The  explanation  of  finding  hydrochloric  acid  in  gastric  juice  is  that 
lactic  acid  in  a  nascent  state  decomposes  the  chloride  of  sodium  contained  in 
all  animal  fluids. 


ABDOMINAL    PAINS.  137 

tliu<  arrive  at  two  immediate  causes  of  the  morbid  pheno- 
menon in  question : — 

.  Too  long-continued  acidity  of  the  stomach. 
2d.  Ovrr-sonsitivcMu'ss  of  the  cardiac  and  oesophageal  nerves. 
I  will  point  out  the  action  of  these  two  causes  by  the  citation 
of  some  cases. 

<\— Hon.  Major  C — has  attained  old  age  with  as  little  suffering  from 
illness  as  most  people.     What  brings  him  to  consult  me  is  a  painful  sensation 
up  from  the  epigastrium  to  the  hack  of  the  throat  at  uncertain  times 
(generally  from  three  to  four  hours)  after  food.     He  is  able  to  prevent  it  by 
I  very  little.  but  he  fears  that  what  he  takes  under  this  restriction  is  not 
enough  to  nourish  him.     He  is  also  able  to  cure  it  temporarily  by  Soda  or 
!i.   but   has  heard  that  is  a  bad  habit.     Though  he  is  old,  he  wants  to 
be  cured.     His  mouth  gets  very  dry  from  lack  of  saliva.     I  advised  him  at  his 
age  not  to  be  too  solicitous  for  a  second  youth,  but  ordered  a  Quinine  mixture 
with  a  grain  and  a  half  of  Iodide  of  Potassium  to  be  taken  twice  a  day  fora 
few  consecutive  days  occasionally.    It  seemed  to  agree  with  him,  and  the  dry- 
ness  of  mouth  was  less. 

The  object  of  the  Iodide  of  Potassium  was  to  increase  the 
secretion  of  saliva;  but  I  did  not  assign  the  whole  of  the  indi- 
>n  to  the  deficiency  of  this  fluid,  considering  it  rather  as 
an  eft'ect  of  the  sluggishness  natural  to  old  age.     At  that  period 
of  li!  .ercise  is  taken  and  less  food  required;  so  that  the 

quantity  of  the  diet  should  be  accommodated  to  the  years.     If 
it  be  not  so,  the  overladen  organ  labors. 

CI. — M  .   d  10, consulted  me  in  April.  1857.  about  an  inter- 

mittent hemicrania  \vlii--h  had  come  on  recently  through  living  in  an  aguish 
district.  She  had  a  look  of  chronic  invalidism  more  than  was  justified  by  the 
malarious  infection,  and  on  inquiry  I  found  that  for  many  years  she 
had  suffered  from  what  she  called  "risings  in  the  throat,"  which  came  on 
about  three  hours  after  meals.  Dinner  was  the  most  painful  meal.  If  nothing 
came  ti]»,  as  was  usually  the  case,  the  "  risings"  continued  two  hours  or  more, 
and  went  away  gradually.  Hut  if  by  a  semi-voluntary  effort  she  turned  the 
••  rising"  into  an  ejection  of  a  small  quantity  of  food  and  air,  relief  followed. 
On  these  occasions  what  she  brought  up  was  very  acid  to  taste  and  smell.  She 
had  been  physicked  at  various  times  in  previous  years  for  this  heartburn  with- 
out benefit,  and  had  learnt  to  bear  it.  She  found,  indeed,  that  Soda  gave 
temporary  ease ;  but  fancied  the  symptoms  were  aggravated  by  a  persi- 
in  the  remedy,  and  despaired  of  beinir  ever  better.  She  came  to  be  cured  of 
her  headache.  For  this  1  prescribed,  and  killed  two  birds  with  one  stone,  for 
she  was  later  led  to  volun1  that  the  l^niume  I  gave  her  to  cure 

the  hemicrania  did  the  heartburn  good  also. 


138  ABDOMINAL    PAINS. 

It  is  this  last  observation  which  leads  to  my  here  quoting 
the  case 

By  three  hours  after  meals  the  stomach  ought  so  far  to  have 
emptied  itself  that  the  cardia  should  not  be  distended,  and  the 
orifice,  relieved  of  the  pressure  of  acid  matters,  should  be  enjoy- 
ing the  change  of  a  trickling  flow  of  alkaline  saliva.  Though 
the  general  contents  of  the  stomach  may,  and  indeed  ought,  to 
remain  acid  longer  than  that,  yet  the  lower  orifice  of  the  oeso- 
phagus requires  a  period  of  alkalinity,  and  suffers  if  it  does  not 
get  some. 

Note — that  the  throwing  up  of  a  small  quantity  gave  relief, 
because  it  brought  the  stomach  into  a  normal  condition  as  to 
contents. 

Note — that  what  is  brought  up  in  heartburn  was  acid,  show- 
ing a  free  communication  with  the  stomach,  and  therefore  that 
the  oesophagus  was  pervious,  not  spasmodically  contracted,  as 
the  patient's  sensations  led  her  to  believe. 

This  form  of  heartburn  frequently  comes  on  at  night,  pre- 
venting sleep. 

Sometimes  the  patients  will  say  they  have  "pain  before  food," 
which  pain  on  inquiry  turns  out  to  be  postponed  heartburn 
arising  from  the  last  meal. 

CASE  GIT. — Eev.  E.  M — ,  aged  26,  has  worked  so  hard  to  raise  himself  to 
be  fellow  and  tutor  of  his  college  that  he  has  injured  his  digestion.  The  false 
appetite  which  intellectual  exertion  brought  on,  made  him  overload  the 
stomach  at  dinner  with  more  than  it  could  part  with  by  next  meal.  This 
induced  a  pain  not  exactly  like  that  of  hunger  before  each  meal,  accompanied 
by  a  sensation  as  of  something  rising  up  into  the  fauces.  No  vomiting  or 
eructation,  though  the  stomach  evidently  was  not  empty.  He  had  besides 
some  curious  nervous  symptoms,  for  which  I  gave  him  Quinine  and  Strychnine, 
and  he  got  better  of  all  together. 

CASE  CIII. — Mr.  John  H — ,  aged  42,  came  to  me  February  7th,  1866,  com- 
plaining of  pain  at  the  epigastrium  towards  the  left  side,  rising  up  in  parox- 
ysms to  the  fauces,  and  which  was  shown  to  be  only  heartburn  by  the  absence 
of  tenderness  on  pressure.  He  declares  it  does  not  come  on  till  full  four 
hours  after  food,  and  it  passes  into  hunger  for  the  next  meal. 

It  is  almost  as  common  in  practice,  especially  among  the 
educated  classes,  to  find  heartburn  complained  of  as  coming  on 
within  the  first  hour  after  meals. 


ABDOMINAL    PAIXS.  139 

\". — Ilonry  S — ,  aired  about  H).  a  solicitor  in  large  country  prac- 
,une  t«>  mi-  in  March,  ls.~>('..  complaining,  among  other  things,  of  heart- 
burn commencing  within  an  hour  of  every  meal.  He  had  sometimes  made  a 
strong  effort  at  eructation  and  brought  up  some  of  the  contents  of  the  stomach, 
hut  it  gave  him  no  relief.  What  he  brought  up  did  not  taste  particularly 
soar,  and  consisted  of  whatever  he  had  eaten.  I  prescribed  him  a  course  of 
Hydrocyanic  Acid  ("liv  in  Infusion  of  Gentian  three  times  a  day).  He  con- 
tinue.1  tn  take  that  till  quite  well,  and  remained  well  till  a  hasty  journey  to 
Vienna  in  the  autumn  of  1860  brought  on  an  attack  of  diarrhoea  and  great 
ition.  After  this  his  old  symptoms  returned,  and  were  again  appeased 
by  Hydrocyanic  Acid  and  a  Blister  to  the  scrobiculus  cordis. 

It  is  among  anxious  sensitive  persons  that  we  usually  find 
this  kind  of  heartburn,  even  although  they  may  not  be  so  intel- 
;:tlly  and  SBfltbetioally  endowed  as  the  last-named  sufferer. 

<   \-K  TV. — Mr.  W — ,  a  cheesemonger,  aged  30,  came  to  me  last  January 
for  a  feeling  of  pain  rising  up  from  the  epigastrium  to  the  back  of  the  throat, 
-!imke  arose  from  the  stomach,  usually  under  three  quarters  of  an  hoar 
after  meals.     If  he  ate  supper,  this  would  happen  in  bed  and  give  him  sleep- 
Jit-:. 

lie  was  an  uneducated  soul-less  man,  but  had  worried  himself  a  good  deal 
about  his  trade,  and  was  also  anxious  about  his  health,  so  that  his  tongue  had 
the  quiver  and  the  wet  white  coat  of  an  overwrought  intellectual  woman's. 

n fill   doubtless   the   largeness   of  the   meal   contributes 
-.sly  to  the  severity  of  the  heartburn  with  acidity,  it  is  by 
no  means  an  essential  in  its  production. 

l  CVI.— During  1801  and  1862  I  attended  the  wife  of  a  retired  Anglo- 
Indian  physician,  aged  about  40,  for  general  sluggishness  of  the  alimentary 
canal.  accompanied  by  a  tendency  to  mucous  discharge  p<>r  union.  She 
puflercd  at  fir.-t  a  -reat  deal  from  "acidity"  within  the  first  three  hours  after 
meals.  Imt  .-one-times  sooner.  She  constantly  averred,  and  indeed  at  my  re- 
quest subjected  the  matter  to  the  test  of  experiment,  that  a  small  quantity 
of  bread,  or  any  other  simple  food,  brought  on  the  acidity  as  certainly  as  a 
full  meal.  That  this  was  due  to  sluggish  action  of  the  gastric  muscular  fibres 
was  evidenced  by  her  deriving  benefit  from  Strychnine;  but  that  it  was  not 
wholly  M>  to  lie  debited,  its  early  supervention  showed. 

Now  in  the  first,  second,  third,  and  fourth  of  th«'se  specimen 
cases  we  may  fairly  accuse  the  stomach  of  atonic  sluggish 
by  which   its  normal!  its  arc  detained  too  Ion 

their   passage,   and  the  n-  1  too  long   to  that  acid. 

But  in  the  next  two  the  pain  cannot  be  debited  to  prolo 


140  ABDOMINAL    PAINS. 

exposure,  for  it  would  be  an  exceedingly  abnormal  thing  if  the 
cardia  were  not  acid  at  that  time.  There  must  have  been  an 
over-sensitiveness  of  the  gastric  plexus.  The  last  (Case  CVI) 
is  a  transition  case,  which,  though  it  stands  alone  here,  really 
represents  a  larger  number  than  the  others,  namely,  those  which 
are  a  transition  between  the  classes,  presenting  the  character- 
istics of  both  in  various  degrees.  We  may  take  the  marked 
cases  as  the  two  ends  of  the  scale,  between  which  the  majority 
of  our  patients  vibrate. 

Although,  therefore,  it  is  impossible  to  make  a  clear  division 
of  our  patients  into  the  two  classes,  yet  has  the  distinction  an 
importance,  for  the  nearer  the  symptom  occurs  to  the  meal  the 
more  is  it  due  to  hyperassthesis,  and  the  further  off  the  more 
to  slow  digestion. 

And  with  an  eye  to  this  pathology  are  the  patients  best 
treated.  First,  as  regards  the  immediate  popular  relief  by  alka- 
lies :  when  the  heartburn  does  not  come  on  till  four  hours  or 
so  after  a  meal,  an  alkali  may 'be  safely  taken  even  habitually; 
it  is  time  for  the  stomach  to  be  losing  its  acidity,  and  there  is 
no  harm  in  assisting  nature.  Still  it  must  be  remembered  that 
this  temporary  antidote,  taken  in  this  way,  is  not  a  cure.  But 
if  the  heartburn  comes  on  within  about  an  hour  of  the  inges- 
tion  of  food,  an  alkaline  neutralization  of  the  gastric  contents 
is  positively  abnormal  and  injurious.  'It  prevents  the  due 
digestion  of  the  food,  and  so  deprives  the  body  of  nutriment. 
It  induces  anaemia,  debility,  and  possibly  some  of  the  further 
ills  to  which  these  powerful  degenerators  lead. 

In  the  cases  with  a  preponderance  towards  the  latter  class 
local  anesthetics  come  into  play.  Opium  and  its  salts,  Bismuth, 
Zinc,  Silver,  Henbane,  are  all  of  use  as  a  change,  but  the  main 
stay  of  the  practitioner  is  Hydrocyanic  Acid.  It  does  more 
good  combined  with  less  harm  than  any  other  remedy.  Car-- 
bonic  Acid  is  also  a  harmless  anesthetic,  and  indeed  a  normal 
one,  for  the  natural  atmosphere  of  mucous  membranes  is  Car- 
bonic Acid.  I  have  sometimes  persuaded  people  to  take  Car- 
bonated (aerated)  Water  instead  of  Soda,  and  they  have  experi- 
enced an  equal  relief.  I  have  sometimes  combined  a  Blister 
with  Hydrocyanic  Acid,  from  my  observation  of  the  effect  of 


ABDOMI.VAI,    PAIN'S. 

-  in  pleurodvnia,  ami    I  am  inclined   to  think  it  anaes- 
thetic in  :i.     But  it  is  a  disagreeable  measure. 

Mineral  acida  are  of  more  use  in  the  heartburn  of  sluggish 

indigestion  tlian  in  the  hyperaesthetic ;  but  I  think  they  seldom 

cure  without  the  aid  of  other  more  potent  tonics.     One  great 

tion  to  their  use   is  their   injurious  action  on  the  teeth. 

•'.•11  me  that  we  physicians  make  more  work  for  them 

than  any  other  external  enemy  to  the  integrity  of  the  grinders 

by  our  administration  of  mineral  acids.     In  consequence  I  have 

mad-  -vials  of  Acetic  Acid  as  a  substitute,  but  without 

much  encouragement  to  persevere. 

In  hypera-sthetio  heartburn  the  chewing  a  piece  of  Liquorice 

slowly  in  the  mouth  will  often  be  of  great  service,  especially 

when  it  occurs  in  pregnant  women,  to  whom  one  is  loath  to 

administer  drugs  without  strong  cause.     Howsoever,  the  final 

reliance  of  the  physician  for  cure  must  be  in  a  renewal  of  the 

rs  of  life  by  tonics,  especially  by  nerve-tonics,  especially 

v"iinine  and  Strychnine:  and  then,  when  a  step  of  progress 

has  been  made  with  these,  by  the  restoration  of  the  blood  with 

Iron.    I  will  not  tarry  over  the  shapes  in  which  these  remedies 

be  administered — I  am  careless  of  the  form  so  that  I  get 

instance.     Some  forms  may  be  better  than  others,  but  all 

are  good,  and  all  distance  competitors  so  far,  that  their  mutual 

rivalry  is  of  no  moment.     It  will  be  seen  that  in  all  the  c 

I  quote  resort  is  had  to  these.    They  are  always  at  hand,  always 

and  within  the  reach  of  all  purses;  which  last  cannot  be 

<>f  the  tonic  I  am  now  coming  to. 

I  have  spuken  of  alkalies  as  a  temporary  palliative  in  heart- 
burn.    There  is  another  way  in  which  they  are  sometimes  em- 
•  •d  with  advantage,  and  which  may  be  described  fairly  as 
their  "restorative"  use.     I  refer  to  their  administration  in  a 
•ourse,  the  dose  bein^  taken  rather  at  the  times 
when    tin-re   is   no  heartburn  than  when  there  is.     The   effect 
aimed  at  is  that  consequence  of  alkalies  pointed  out  by  Claude 
.ml,  the  augmentation  of  the  acid   -a.-tric  juice,  and  so  of 
.onua!  |  ,  ,  (f  the  stomach. 

Tl.  'ceneiit  bein.i:  derived  from  a  course  of  alkali   is 

the  dose  not  re,|,iirin-  to  be  increased  as  the  patient   goOf 

taking  it,  but  on  the  contrary  being  capable  of  being  diminii 


142  ABDOMINAL    PAINS. 

gradually,  while  relief  from  the  recurrence  of  heartburn  con- 
tinues still  to  be  experienced.  This  shows  that  the  real  health 
of  the  stomach  is  being  restored ;  that  a  renewed  life  is  de- 
veloped. 

But  should  the  patient  be  driven  by  recurring  pain  to  take 
larger  and  larger  doses,  it  is  evident  that  the  palliation  is  simply 
a  neutralization  of  the  normal  acid  of  the  gastric  contents.  This 
induces  in  the  end  weakness  and  over-sensitiveness,  and  such 
patients  will  in  a  very  short  time  appear  again  under  medical 
care,  usually  in  a  worse  condition  with  each  recurrence;  or  they 
will  become  chronic  druggers  for  life,  or  perhaps  be  finally 
cured  by  some  clever  quack  who  amuses  their  fancy  while  he 
bids  them  abstain  from  active  remedies. 

Now  I  think  that  the  due  administration  of  a  course  of  alka- 
lies is  best  secured  by  the  systems  followed  at  certain  Continental 
spas.  I  believe  their  reputation  as  panaceas  of  all  bodily  ills 
to  spring  from  the  renewal  of  the  digestion  which  this  mode 
of  administration  of  an  alkaline  course  is  likely  to  bring  about, 
and  from  the  intimate  connection  which  there  is  between  the 
digestion  and  all  other  parts  of  the  body. 

"We  must  not  let  ourselves  be  prejudiced  against  courses  of 
mineral  waters  by  the  little  packets  of  nonsense,  brought  by 
post  under  various  foreign  stamps,  which  set  forth  in  laughable 
Anglo-French  the  omnipotence  of  their  own  "  Abana  and  Phar- 
par."  Doubtless,  like  the  lady  in  Hamlet's  play,  they  do 
"  protest  too  much ;"  but  there  is  some  good  in  them  for  all  that. 
Patients  get  there  something  more  than  the  over-puffed  and 
many-tested  springs — Air,  Best,  Gentle  Exercise,  New  Diet, 
Change  of  Scene,  Freedom  from  Domestic  Nagging,  and  per- 
haps from  Domestic  Physicking,  &c.  These  would  do  good, 
were  the  waters  even  moderately  poisonous.  But  the  fact  is 
they  are  not  at  all  poisonous,  and  many  of  them  contain  not 
only  Carbonic  Acid,  which  is  a  gentle  normal  anesthetic  to 
mucous  membrane,  but  also  Carbonate  of  Soda,  which  rightly 
administered  has  been  shown  capable  of  increasing  the  digestive 
powers  of  the  stomach.  The  right  administration  consists  in 
giving  it,  not  when  the  organ  is  full,  and  ought  to  be  acid,  but 
when  it  has  parted  with  nearly  all  its  contents,  at  a  time  as 
distant  as  possible  from  the  meals. 


ABDOMINAL    PAINS.  143 

When,  therefore,  I  wish  to  prescribe  a  course  of  alkali,  I 
think  a  better  plan  cannot  be  devised  than  sending  the  patient 
-pa  containing  that  ingredient,  and  desiring  them  to  arrange 
with  the  superintendent  times  for  taking  the  waters  in  accord- 
ance with  the  above  rules. 

Of  the  two  most  famous  alkaline  spas,  Vichy  and  Vals,  I 
r  the  latter,  because  the  water  contains  such  a  large  pro- 
portion of  Iron  (retained  in  a  state  of  Carbonate  by  the  excess 
of  Carbonic  Acid),  which  assists  much  in  the  restoration  of 
strength  to  the  stomach.     Moreover,  Vals  is  further  off,  and  in 
the  neighborhood  of  beautiful  and  romantic  scenery,  enough 
iijtt  the  patients  to  a  tour,  and  to  help  them  to  shake  off 
the  invalidism  which  associating  with  sick  people  at  the  spa  is 
apt  to  induce. 

In  reflecting  upon  the  purely  medicinal,  exclusive  of  the 
psychical,  benefits  conferred  by  spas,  we  must  remember  not  to 
attribute  all  even  of  them  to  the  salts  contained  in  the  analysis. 
Water  itself  is  an  important  constituent  of  the  gastric  juice,  and 
an  augment  to  its  quantity  and  power.  It  is  a  direct  re>t<>rative 
agent,  perhaps  the  most  powerful  of  all  drugs.  No  minutiae, 
therefore,  of  its  administration  are  frivolous,  and  the  following 
additional  hints  as  to  drinking  at  the  spa  are  not  to  be  consi- 

•;  impertinent.     Let  the  drinker  reflect  on  the  physiolo.-- 
action  of  temperature  on  the  gastric  nerves.     Small  quantities 

i  coM  act  as  a  tonic  shower-bath,  and  remove  local  coi 
tion ;  but  if  much  is  drunk  at  a  time,  a  great  depression  of 
vitality  follows.  Let  therefore  the  cold  doses  be  small.  But 
•  !y  the  same  reason  warm  or  tepid  springs  may  be  taken 
in  considerable  quantities,  and  a  renewal  of  vitality  be  expe- 
rienced.1 

The  local  application  to  the  epigastrium  of  variations  of  tem- 

•:ire  is  often  of  use  to  persons  with  a  diathesis  to  heartburn, 

i-led  there  is  no  catarrh  of  the-  gastric  mucous  membrane. 

It  mav  be  applied  by  the  alternation  of  a  cold  and   hot   douche 

to  pit  of  the  stomach — in  which  case  the  alternations  must  be 

rapid,  and  the  time  of  application  short,  say  one  minute  or  two 

1  I  am  told  by  travellers  in  Central  America  that  the  Indian  porters  preparing 
for  a  Ion.;,  hard  journey  will  driuk  several  quarts  of  quite  hot  water.  They  say 
it  gives  them  strength. 


144:  ABDOMINAL    PAINS. 

minutes  each  ;  or  to  the  back,  in  the  situation  of  the  dorsal  and 
upper  lumbar  vertebrae — when  a  very  much  longer  application 
is  desirable,  namely,  as  long  as  the  patient  can  bear  it  without 
losing  the  consequent  reaction.  In  spite  of  the  thickness  of 
various  tissues  which  lie  between  the  skin  of  the  back  and  the 
stomach,  the  dorsal  douche  is  very  efficient.  When  a  regularly 
built  douche  bath  is  not  accessible,  a  hydropult  garden  machine 
is  a  good  substitute,  or  a  slab  of  ice  or  ether  spray  may  be  in- 
geniously made  to  take  its  place. 

I  have  been  led  on  by  the  frequency  of  heartburn  in  cases  of 
indigestion  to  pass  from  its  special  treatment  into  that  of  the 
general  management  of  the  patient.  Perhaps  the  reader  will 
have  said  that  the  last  few  pages  would  have  been  more  in 
place  at  the  end  of  the  second  chapter.  It  will  be  easy  to  sup- 
pose them  transferred  there  if  he  wishes  it.  But  yet  I  am  not 
sorry  to  let  it  be  seen  how  difficult  it  is  to  separate  either  in  fact 
or  fancy  the  two  subjects,  and  to  point  out  that  the  cure  must 
not  stop  short  at  the  arrest  of  a  symptom,  but  must  proceed 
to  the  renewal  of  active  life  in  the  organ  whose  sluggishness 
and  deficient  power  of  resistance  to  sensation  is  causing  the 
symptoms. 

SECTION  II. 
Acidity. 

What  is  usually  called  "acidity"  is  the  ejection  from  the 
stomach,  with  or  without  heartburn  preceding,  of  a  small  quan- 
tity of  sour  fluid.  There  is  no  objection  to  the  name,  if  it  be 
remembered  that  it  means  merely  acidity  out  of  place  or  too 
Ions  continued,  and  be  not  allowed  to  lead  to  our  viewing  the 

o  /  o 

normally  acid  state  of  the  gastric  contents  as  an  evil  to  be  com- 
bated. The  fault  of  doing  that  has  been  commented  upon  in 
the  previous  section. 

It  is  not  rare  to  find  acidity  misinterpreted  even  by  those  who 
ought  to  know  better.  I  have  heard  it  spoken  of  as  an  excess, 
"  excess  of  gastric  juice" — that  is  to  say,  too  much  of  a  vital  act, 
too  much  life.  Such  a  mode  of  speaking,  if  it  leads  to  anything, 
must  lead  to  faulty  thinking  and  bad  treatment.  Instead  of 
being  an  excess,  acidity  itself  is  a  proof  of  deficiency. 


ABDOMINAL    PAINS.  145 

VII. — A  medical  imin  complained  to  me  a  year  or  so  ago  of  what 
he  called  "  over-abundance  of  gastric  juice."  "  Why  do  you  call  it  over- 
abundance of  pastrie  juice  ?"  "  Oh,  because  acid  rises  np  in  my  mouth,  and 
three  or  four  hours  after  dinner  I  sometimes  throw  up  my  victuals  so  sour  as 

ko  my  throat  quite  sore."  •'  Well,  now,"  I  said,  "observe  what  comes 
up.  look  at  mie  of  the  pieces  of  meat  in  it,  and  yon  will  see  it  hardly  altered 
from  tin-  conilition  in  which  it  was  swallowed.  But  look  at  what  a  healthy 
person  throws  up  when  made  to  vomit,  say  by  sea-sickness,  four  hou/s  after 
a  meal  ;  it  is  all  homogeneous,  and  the  lumps  of  meat  are  quite  broken  up.  If 
you  really  secreted  an  over-abundance  of  gastric  juice,  you  would  have 

••••I  your  meat  more  quickly,  instead  of  less  quickly  than  the  healthy 
•  ii." 

We  know  by  experiments  on  artificial  digestion,  that  an  in- 

the  quantity  of  the  solvent  secretion  quickens  the 

solution  of  albumen.     "We  find,  for  instance,  that  the  amount 

of  pepsine  contained  in  twenty  grains  of  Boudault's  powder  will 

've  a  piece  of  hard-boiled  white-of-egg  much  sooner  than 
five  grains.  The  same  thing  would  of  course  happen  in  the 
stomach  :  were  there  more  gastric  juice,  there  would  be  quicker 
digestion.  But  in  acidity  such  is  notoriously  not  the  case;  the 
aliments  lie  for  a  long  time  in  the  upper  part  of  the  digestive 
canal,  and  often  are  passed  still  undissolved  in  the  feces.  It  is 
a  chemical  act  of  decomposition  directly  opposed  to  the  vital 
act  of  digestion. 

I  call  a  "  vital"  act  any  which  forms  part  of  the  great  circle 
of  life,  such  as  is  the  conversion  in  the  stomach  of  albumen, 
previously  incapable  of  solution  and  absorption,  into  peptone 
capable  of  entering  the  circulation.  Now,  when  this  vital  act 
of  conversion  is  carried  on  with  rapidity  by  a  stomach  makinir 
abundance  of  gastric  juice  strong  in  pepsine,  then  chemical 
decomposition  i>  prevented  :  nay,  it  is  even  arrested  after  it  has 
commenced,  ;ls  j,,  .n  by  putrid  meat  not  becoming  more 

but   less   putrid   as    it    passes  through   the   body  of  a  healthy 
animal.      But  when   the  conversion    is   slowly  or   imperfectly 

•rmed,  then  the  chemical   change  has  time   to  take  place, 
and  does  so  very  soon,  being  favored  by  the  heat,  moisture,  and 

ttio  matter   in  a  state  of  change.     If  the  food   remain  too 

without  becoming  chyme,  the  protein  compounds  putrefy 
with  extreme  rapidity  under  such  circumstan 

The  following  simple  experiments  make  the  matter  verv  dear 
10 


146  ABDOMINAL    PAINS. 

to  yourself  or  a  class.  As  far  as  his  own  improvement  is  con- 
cerned, the  skilled  physiologist  may  skip  the  next  page  or  two 
without  loss. 

Compare  some  hard-boiled  white-of-egg  which  has  been  im- 
mersed in  saliva  at  the  temperature  of  100°  Fahr.  for  a  day, 
with  another  portion  from  the  same  egg  kept  the  same  time  in 
distilled  water.  Your  nose  warns  you  of  the  difference  directly ; 
the  first  is  intolerably  fetid,  the  second  quite  sweet.  Exactly 
similar  is  the  fate  of  undigested  albuminoid  matter,  whether 
animal  or  vegetable,  in  contact  with  the  mucous  membrane 
inside  the  body. 

But  how  does  that  affect  the  case  of  acidity  ?  Try  another 
experiment.  Put  in  one  beaker  some  syrup  of  grape  sugar,  and 
it  remains  for  hours  quite  neutral  and  natural.  Set  to  soak  in 
some  of  the  same  a  piece  of  putrefying  albumen  for  a  few  hours, 
and  keep  the  mixture  at  the  temperature  of  the  body.  You 
find  that  a  piece  of  litmus  paper  put  in  it  is  strongly  reddened, 
showing  the  copious  formation  of  lactic  acid.  In  another 
beaker,  the  formation  of  butyric  acid  from  fresh  butter  by  the 
same  means  may  be  shown. 

Just  so  all  the  grape  sugar  and  fat  swallowed  meeting  in  the 
stomach  or  intestines*  with  decomposing  animal  food,  collected 
in  a  mass  or  glued  to  the  side  by  a  too  sticky  mucus,  ferments 
quickly  throughout,  and  forms  lactic  and  butyric  acids  in  great 
quantity. 

Eemember,  the  grape  sugar  swallowed  seems  something  much 
more  important  than  merely  the  gtape  sugar  put  in  the  mouth. 
Take  some  boiled  starch,  and  heat  some  of  it  with  potassio- 
tartrate  of  copper.  There  is  no  change  in  the  blue  color  of  the 
salt.  Now  put  some  in  the  mouth,  and  hold  it  a  few  moments. 
When  it  is  again  heated  with  potassio-tartrate  of  copper,  the 
metal  is  precipitated,  and  shows  by  its  brilliant  yellow  color  an 
abundant  quantity  of  sugar. 

The  saliva  then  begins  to  convert  starch  into  sugar  immedi- 
ately ;  very  soon  it  will  transform  the  whole  mass.  A  mouthful 
of  boiled  starch  held  in  the  mouth  for  five  minutes  will  show 
afterwards  scarce  a  trace  of  starch  remaining.  As,  even  amongst 
wealthy  meat-eating  nations,  from  half  to  five  sixths  of  the  solid 


ABDOMINAL    PAINS.  147 


food  •  ••!'  stan-h,1  it  is  evident  that  one  of  the  most  bulky 

contents  of  the  .-tomach  must  be  the  sugar  which  has  been  n. 
by  the  saliva  out  of  amylaceous  food.  Here,  then,  is  ample 
material  for  the  formation  of  lactic  acid  to  almost  any  amount. 
Add  to  this  the.  oleaginous  substances  which  it  is  impossible  to 
avoid  in  any  diet,  and  which  from  being  insoluble  in  water  turn 
into  peculiarly  acrid  and  concentrated  acids,  and  you  will  have 
no  difficulty  in  accounting  for  acidity,  without  recurring  to  a 
theoretical  excess  of  gastric  juice.  Acidity,  then,  is  an  evidence 
of  chemical,  and  therefore  of  decreased,  vital  action  —  a  proof  of 
incomplete  digestion,  of  deficient  activity,  in  the  stomach. 

There  is  nothing  in  acidity  to  contra-indicate  the  employment 
of  acids  as  remedies.  They  are  often  most  beneficial,  especially 
if  taken  shortly  before  a  meal.  The  best  to  select  are  those  to 
which  the  digestive  canal  is  most  used,  Hydrochloric  or  Lactic 
in  plain  water.  The  way  in  which  they  act  is  probably  by  neu- 
tralizing the  alkline  saliva  and  mucus  which  the  slow  digestion 
allowed  to  accumulate  in  the  stomach,  and  so  setting  at 
liberty  the  pepsine  ;  for  in  laboratory  experiments  it  is  found  that 
saliva  arrests  the  solvent  power  of  pepsine  in  close  proportion 
to  its  amount,  and  that  by  acidifying  the  mixture  the  action  may 
be  restored. 

ther  is  there  anything  in  the  use  of  acids  inconsistent 
with  a  contemporaneous  course  of  alkalies,  so  that,  of  course, 
they  are  not  mixed  immediately  they  are  swallowed.  They 
mav  each  act  separately  with  benefit  on  the  mucous  membrane 
and  nerves,  and  then  the  sooner  they  neutralize  one  another 
into  a  salt  and  are  got  rid  of  the  better. 

I  have  indeed  heard  physiologists  deride  the  idea  of  taking 
nie.lieines  f'-r  ''acidity,"  as  if  it  implied  our  ignorance  of  the 
•omach  being  normally  acid,  especially  at  its  most 
comfortable  times.  The  1-est  answer  to  them  is  that  we  give 
medicine  for  acidity  of  //">////,,  which  they  cannot  assert  to  be 
normal.  It  is  a  superficial  answer,  but  the  objection  is  super- 
ficial also.  Of  course  in  reality  a  man  is  not  a  retort  or  a 
tube. 

••  the  dietaries  of  soldiers,  prisoners,  laborers,  and  others,  analyzed  hy  Dr. 

in  "  Die  Normal  IM.it,  "  j..  G.     Berlin,  ! 


1-iS  ABDOMINAL    PAIXS. 

Some  patients  will  perhaps  think  that  their  physician  is 
blowing  hot  and  cold,  or  rendering  inert  his  own  treatment,  by 
ordering  acids  at  one  time  and  alkalies  at  another ;  and  he  will 
find  it  a  wise  plan  to  give  an  educated  person  a  short  physio- 
logical lecture  on  the  subject,  explaining  the  reason  of  his  pro- 
cedure. He  may  explain  also  that  the  acids  given  as  medicine 
do  something  more  than  in  the  laboratory;  they  stimulate  the 
mucous  membrane,  and  so  actually  increase  the  quantity  of 
secretion  while  they  intensify  its  power.  There  need  be  no 
fear,  which  I  have  heard  some  express,  that  the  use  of  these 
substitutes  for  the  natural  constituents  of  the  gastric  juice,  or 
rather  the  supply  of  that  which  ought  to  exist  in  the  gastric 
juice,  will  teach  the  stomach  to  be  lazy — as  doing  a  servant's 
work  for  him  makes  him  less  equal  to  doing  it  himself.  On 
the  contrary,  the  new  vigor  put  into  the  system  by  the  healthier 
and  more  copious  chyme  that  is  formed,  renders  the  organ 
more  active;  so  that  it  soon  is  enabled  to  go  on  secreting  for 
itself  what  is  wanted,  and  to  do  without  the  artificial  substitute. 
If  patients  derive  benefit  from  it,  they  will  be  able  soon  to  leave 
it  off. 

There  is  a  singular  febrile  disease  mentioned  by  M.  Chomel 
in  "Les  Dyspepsies"  as  an  acute  acid  dyspepsia,  in  which  the 
whole  body,  in  point  of  fact,  turns  sour.  As  might  be  ex- 
pected, it  seems  to  be  invariably  and  rapidly  fatal.  I  confess 
I  do  not  recognize  it  from  his  description.  The  case  he  gives 
seems  more  like  one  of  pyaemia  than  anything  else  in  my  expe- 
rience. But  its  extreme  rarity  takes  away  most  of  the  interest 
which  would  attach  to  it,  and  its  incurability  the  rest. 

SECTION    III. 
Waterbrash 

(or  Pyrosis)  has  so  far  a  similar  local  pathology  with  heart- 
burn, in  that  the  manifestations  of  the  phenomenon  is  in  the 
oesophagus.  There  is,  however,  this  difference,  that  the  spasm 
which  there  seems  to  be  subjective  only,  is  here  exhibited  as  a 
muscular  contraction.  The  tube  is  closed  by  it,  and  the  pas- 
sage into  the  stomach  of  the  saliva  trickling  downwards  is  pre- 


ABDOMINAL    PAINS.  149 

vented,  so  that  it  collects  in  considerable  quantities,  and  gushes 
iij>  into  the  mouth  without  any  effort  of  vomiting.  The  fluid 
in  its  pure  state  is  therefore  alkaline,  and  exhibits  under  the 
microscope  no  other  formed  contents  except  the  buccal,  faucial, 
ami  oesophageal  epithelium. 

In  his  valuable  monograph  on  the  diseases  of  the  stomach 
Dr.  Ilandfield  Jones  has  represented  waterbrash  as  a  watery 
catarrh  of  the  mucous  coat  of  that  organ,  analogous  to  bron- 
chorrhcea,  for  example.  Now,  if  that  were  so,  it  would  contain 
ic  and  not  salivary  elements;  and  it  would  also  be  filled 
with  mucous  globules,  as  the  flux  of  nasal  or  bronchial  catarrh 
is.  It  would  also  always  be  ejected  by  a  distinct  effort  of 
vomiting  and  nausea,  which  is  the  case  only  when  the  contents 
of  the  stomach  are  mixed  with  it. 

The  alkaline  nature  of  the  fluid  of  waterbrash,  contrasted 
with  the  acidity  of  ordinary  regurgitations,  has  been  made  by 
some  a  groundwork  for  a  primary  division  of  indigestions  into 
aci'l  and  alkaline.  It  will  be  seen  by  the  following  pages  that 
I  should  consider  this  an  arbitrary  and  artificial  division,  with- 
out practical  utility  or  basis  in  nature.  Acid  and  alkaline 
;ions  are  often  found  on  the  same  day  in  the  same 
person;  so,  if  the  stomach  were  a  mere  alembic,  they  would 
cure  one  another.  But  it  does  not  answer  to  treat  of  a  living 
body,  as  if  it  were  a  chemical  laboratory. 

The  following  case  exhibits  the  principal  features  of  the  dis- 
•: — 

i  \ '  1 1 1.-  Margaret  S— ,  aged  22,  an  Irish  maid-of-all-work  in  a  small 
-man's  family,  stupid,  ignorant,  and  bowed  down  in  spirits,  applied  for 
advice  at  Si.  Mary's,  April  li'.th.  lHf>.">,  for  what  she  called  "  sickness  at  heart" 
'•'in)  and  ••  vomiting."     She  had  been  ill  about  two  months, 
during  which  time  what  she  called  ••sickness"  had  occurred  daily.    She  looked 
in  pain,  and  prc-.Mire  on  the  pit  of  the  stomach  showed  it  to  be  tender  when 
<  d  wiili  one   finger's  point   in   the  canliac   region,  though  the  flat   palm 
laid  on  the  spot  cau>ed   no  mie;isine.->.     This   pain  was  also  increased  by  eat- 
ing, especially  potatoe-.  I. read,  and    tea.  of  which   her  diet    chietly   consisted. 
She  was  admitted  as  an   in-patient,  and   then  we  had  the  opportunity  of  ob- 
serving that  what   she  called   vomiting  had   not    really  that   character.     She 
:  nctatioiir-  two  or  three  hours  after  meals.      Hut   this  in- 

eonvi-nience  mostly  occurred  at  ni-lit.  eea>;ii^  Inwards  morning  with  the 
deptll  of  sleep.  \\  \\t  n  .-lie  began  to  move  about  for  the  plirpo.-e  of  ri>ills.r  IX 

Midden  Lru.-h  of  fluid  would  come  into  the  mouth  once  and  auain.  but  seldom 


150  ABDOMINAL    PAINS. 

or  never  a  third  time.  There  was  no  retching  or  effort,  and  no  marked  sen- 
sation of  distress  or  of  relief.  The  quantity  was  seldom  more  than  five  to  six 
ounces.  Preserved  in  a  vessel,  it  was  colorless,  slightly  opalescent,  alkaline, 
and  a  little  adhesive,  like  thin  saliva.  Under  the  microscope  it  exhibited 
large  pavement  epithelium  and  a  few  granular  globules.  Later  in  her  resi- 
dence in  the  hospital  it  was  sometimes  found  less  transparent  and  acid,  as  if 
some  remaining  contents  of  the  stomach  were  mixed  with  it.  The  tongue 
was  red  in  the  centre,  with  white  coated  edges ;  the  catamenia  had  been  irre- 
gular for  some  months. 

She  had  had  a  similar  illness  the  previous  year,  but  had  recovered  by  rest 
and  medicine.  Both  attacks  she  attributed  to  hard  work  and  bad  food. 

She  was  treated  with  Mustard  poultices  and  Leeches  in  several  relays,  at 
first  four  being  applied,  and  then  three  every  other  evening,  for  a  week  or  ten 
days,  on  the  tender  spot  of  the  epigastrium,  with  15  grains  of  Bismuth  thrice 
a  day  for  ten  days ;  then  with  Iron  pills  and  Shower-baths.  Her  diet  was 
principally  broth,  with  milk  and  Lime-water. 

The  Leeches  and  the  Bismuth  seemed  to  relieve  the  eructations  and  the 
pyrosis,  but  the  cardiac  pain  remained  till  she  got  to  Shower-baths  and  Iron. 

Perhaps  the  most  conspicuous  effect  was  that  which  is  to  be  credited  to 
the  diet,  for  she  gradually  gained  twenty-one  pounds  in  weight,  advancing 
from  7  st.  11  Ib.  to  9  st.  4  Ib.  between  the  27th  of  April  and  the  8th  of  June, 
when  she  left  the  hospital  well. 

Observe  that  the  loss  of  blood  by  leeches  did  not  prevent  her 
gaining  blood  and  flesh  by  the  improvement  of  her  digestive 
powers.  The  local  benefits  to  such  an  important  organ  as  the 
stomach  more  than  counterbalanced  the  inevitable  abstraction 
of  what,  truly  enough,  she  could  ill  spare. 

Some  may  cry  out  against  such  treatment  as  inconsistent. 
It  is  feeding  up  the  patient  with  one  hand  and  robbing  him  of 
his  pabulum  vitae  with  the  other.  The  reproach  is  just  in  a 
certain  sense,  but  that  a  very  limited  one,  and  it  may  be 
levelled  against  half  the  operations  of  daily  life.  We  are  con- 
stantly suffering  a  small  loss  for  the  sake  of  greater  gain — 
"  necesse  est  facere  sumptum  qui  quserit  lucrum"  And  I  reckon 
the  absence  of  a  little  blood  as  of  no  moment  at  all  compared 
with  the  advantage  of  securing  freer  circulation  or  diminution 
of  congestion  in  the  alimentary  canal.  Do  not  let  us  be  led 
away  by  the  superficial  notion  that  blood  is  blood,  and  blood  is 
life.  That  is  not  true,  for  blood  varies  immensely  in  its  compo- 
sition, some  being  very  valuable,  and  some  worthless.  To  lose' a 
portion  of  his  imperfect  circulating  fluid  is  but  little  loss  to  an 
invalid,  and  that  little  loss  is  amply  repaid  by  the  additional 


ABDOMINAL    P  A  I  151 

nutriment  which  a  more  rapid  blood-stream  will  enable  him  to 
absorb.  The  deficiency  is  soon  made  up  under  the  restorative 
plan  of  treatment. 

\Vhere  there  is  localized  pain  in  one  spot  of  the  epigastrium 

need  by  pressure  at  all  times,  I  take  the  pathological  con- 
dition to  be  some  local  change  producing  at  least  sanguineous 

''stion  of  the  veins,  if  not  tissue-thickening,  at  that  point. 

:ve  the  importance  in  investigating  such  cases  of  using  the 
ends  of  the  f  nid  not  the  flat  palm,  otherwise  the  phe- 

nomenon may  be  passed  over.  It  is,  perhaps,  needful  to  say 
th:it  the  pressure  exerted  should  be  steady  and  moderate.  It 

-v  to  try  on  yourself  what  amount  a  healthy  epigastrium 
ou -lit  to  endure. 

<  >1  iser ve  the  use  of  Shower-baths.  Their  effect  is  first  to  drive 
the  blood  inwards  from  the  skin,  then  by  nervous  reaction  to 
draw  it  out  again.  Thus  mechanically  the  capillary  circulation 
is  quickened  and  continues  quicker — vires  acquirit  enudo.  Com- 
what  was  said  (page  73)  about  the  increase  of  osmosis 
through  membranes  in  the  direction  of  increased  current. 

It  is  remarkable  how  in  waterbrash  a  separation  is  effected 
by  the  sphincter  extremity  of  the  oesophagus  between  that  tube 
and  the  stomach,  and  what  a  barrier  it  places  between  the  two. 
There  is  no  particular  evidence  of  this  in  waterbrash  which 
occurs  when  the  stomach  maybe  empty  of  food,  in  the  night  or 
early  morning,  as  is  most  usual.  But  sometimes  it  comes  on  at 
or  immediately  after  meals,  and  then  much  surprise  is  caused  to 
the  uninitiated  by  seeing  nothing  of  that  which  is  swallowed 
brought  up  again. 

CASK  CIX. — Last  Anpnst  a  retired  surgeon,  aged  64,  consulted  me  for 

asthma  produced  by  emphys.-matous  lungs.  Latterly,  also,  his  digestion  had 
troubled  him  a  L'reat  deal;  In-  had.  after  exertion,  pain  at  the  scrobiculus  cor- 
<lis.  which  he  attributed  t»  the  diaphragm  overstrained  by  his  dyspna-a,  but 
:>'d  to  in--  more  in  the  stoma«-li.  lie  had  also  wati-rbra>h  occurrinir 
immediately  after,  sometimes  even  during  meals.  He  was  obliged  to  leave  the 
room  and  throw  off  several  ounces,  as  much  as  five  or  six.  of  frothy,  clear, 
cold-tasting  fluid.  Although  this  sometimes  made  him  retch,  yet  the  contents 
of  the  trastric  cavity  were  never  mixed  with  it.  I  gave  him  Quinine  and 
Strychnine  with  apparent  advantage. 

being  frothy  arose  from  the  nearness  of  the  period  of  its 


152  ABDOMINAL    PAINS. 

secretion.     When  it  has  rested  in  the  oesophagus  a  few  hours  it 
becomes  quite  bubble-less,  as  in  matutinal  waterbrash. 

In  the  next  case  a  few  more  details  of  variety  in  the  symptoms 
are  given,  and  a  pretty  good  original  name  for  the  disease  was 
invented  (I  believe)  by  the  patient. 

CASE  CX. — Mary  F — ,  a  widow  of  60  years  of  age,  had  always  enjoyed 
good  health,  and  supported  herself  comfortably  as  a  market-woman  till  she 
"broke  her  arm  in  crowding  to  see  her  son  off  in  a  transport  for  the  Crimean 
campaign.  This  was  in  January,  1855,  and  she  was  thus  naturally  stricken 
down  in  body  and  mind,  and  was  almost  starved,  eating  nothing  but  ill-cooked 
vegetables.  In  May  she  heard  of  her  son's  death,  and  this  was  the  final  blow 
to  her  health.  The  flatulence  and  pain  which  she  had  frequently  felt  at  the 
pit  of  the  stomach  became  more  constant,  and  she  experienced  a  sensation  of 
coldness  there.  She  often  found  her  mouth  suddenly  filled  with  a  "jet"  of 
watery  fluid,  a  symptom  which  she  called  "  watery  mouth."  She  could  swal- 
low the  fluid  by  a  voluntary  effort,  but  the  doing  so  was  often  followed  by 
retching  and  actual  vomiting  of  the  contents  of  the  stomach,  smelling  sour 
and  tasting  acid,  but  small  in  quantity.  Often  in  the  downward  passage  of 
this  or  of  anything  else  she  felt  a  resistance  as  of  "  a  ball  in  the  throat." 
I  The  greatest  quantity  of  fluid  was  brought  up  on  getting  up  in  the  morning, 
when  it  sometimes  amounted  to  half  a  pint;  but  "watery  mouth"  occurred 
at  all  periods  of  the  day,  and  sometimes  immediately  after  meals. 

The  tongue  had  a  white  coat  on  the  edges,  and  was  clean  in  the  centre. 
The  bowels  were  costive.  The  urine  was  slightly  acid,  of  low  specific  gravity 
— 1.012, 1.011,  are  the  numbers  recorded  in  the  case-book  of  the  mixed  urines. 
Her  appetite  for  both  food  and  drink  was  quite  gone,  and  she  felt  an  especial 
aversion  to  animal  food. 

She  was  admitted  to  St)  Mary's  under  my  care  July  6th,  and  discharged 
well  on  August  17th,  1855.  She  was  treated  with  rest,  Bismuth,  two  pints 
and  a  half  of  milk  with  a  pint  of  lime-water  daily,  and  a  graduated  approach 
to  animal  food.  After  eating  she  was  to  take  flsss  of  Alistura  Ferri  Com- 
pnsita  (Pliarm.  Lond.).  By  the  16th  of  July  she  proposed  to  eat  a  whole 
instead  of  a  half  mutton-chop  which  had  been  ordered.  On  the  20th  "  no 
complaint  whatever"  is  the  report,  but  then  she  had  a  relapse,  and  ejected 
some  more  fluid,  and  also  some  rancid  oil.  She  was  then  ordered  Carbonate 
of  Potash  and  Infusion  of  Gentian,  on  which  she  improved  slower  but 
steadier. 

Pains  in  the  epigastrium,  darting  through  the  chest,  are  alluded  to  in  my 
notes,  but  are  not  particularly  described. 

It  has  been  mentioned  that  waterbrash  is  sometimes  called 
vomiting  by  the  patient — "easy  vomiting,"  or  "retching  of 
spittle."  It  is  so  even  when  it  is  evident  that  the  cesophageal 


ABDOMINAL    PAINS.  153 

^e  is  an  obstruction  of  a  permanent  character  preventing 
the  passage  downwards  of  the  saliva.  As  for  instance  in  the 
following  cases. 

CXI. — Francis  P — ,  a  laborer,  aged  57,  was  admitted  to  St.  Mary's 
liter  28th.  1852.  Four  months  previously  he  first  began  to  experience 
;nfort  in  eating  and  nausea.  Often  the  first  few  mouthfuls  swallowed 
would  be  rejected,  after  which  he  would  be  able  to  finish  his  dinner.  He  com- 
plained also  of  pain  in  the  centre  of  the  sternum,  running  through  to  the  back, 
which  kept  him  awake  of  nights.  He  stated  also  that  he  frequently  "  vomited," 
but  the  matter  thrown  up  was  found  to  be  rejected  with  slight,  if  any,  effort, 
and  to  consist  of  clear  alkaline  fluid,  frothy  at  top.  He  stayed  under  my  care 
three  months,  now  better,  now  worse,  sometimes  relieved  by  Bismuth  and 
gaining  a  few  pounds  in  weight.  But  the  pain  -and  dyspepsia  were  not  cured, 
ami  were  considered,  probably  correctly,  to  be  due  to  ulceration  of  the  ceso- 
phagus. 

CASE  CXIL— Mary  S— ,  aged  69,  was  admitted  May  25th,  1855,  for  diffi- 
culty of  swallowing  solids.  The  dysphagia  seemed  dependent  on  two  obstruc- 
tions, one  felt  at  the  top  of  the  sternum  and  the  other  at  the  tip  of  the  ensi- 
form  cartilage.  She  complained  also  of  "  vomiting,"  but  what  she  threw  up 
was  found  to  consist  of  diluted  milk  in  an  alkaline  condition,  thai  is,  diluted 
with  an  alkaline  fluid,  and  evidently  recently  swallowed,  or  else  of  saliva. 
Yet  she  called  it  vomiting,  and  certainly  seemed  to  retch  with  it.  It  was 
never  more  in  quantity  than  five  ounces.  Several  remedies  were  tried  without 
and  she  left  on  June  8th,  discontented  at  not  receiving  an  immediate 
cure. 

The  association  of  an  irritability  of  diaphragm,  exhibited  in 
vomiting,  with  an  irritability1  of  oesophagus,  exhibited  in  the 
spasm  of  waterbraah,  is  again  shown  in  the  following  case. 

1  '  \  1 1 1.-  Mary  Ann  F — ,  a  carpenter's  wife,  aged  52,  was  admitted  to 
iry's  August  4th.  lsf>l.  She  had  been  in  the  habit  for  some  time  of 
taking  her  meals  very  hurriedly,  but  previous  to  that  she  seemed  to  have  suf- 
fered from  various  forms  of  dyspepsia,  originally  due  probably  to  wearing 
tiirht  stays  as  a  girl,  for  her  chest  is  very  much  contracted  by  that  compres- 
sion. The  last  live  weeks  she  had  found  pain,  followed  by  vomiting,  come  on 
about  an  hour  to  an  hour  and  a  half  after  taking  food.  The  vomiting  relieved 
her.  Imt  if  it  did  not  oeeiir.  .-he  had  for  tin-  rest  of  the  day  u  painful  feeling  of 
weight  at  the  epigastrium.  At  various  times  of  the  day  also,  unless  relieved 
by  vomiting,  she  found  clear  water  rise  into  her  mouth,  which  was  usually 
>ss,  but  sometimes  had  a  bitter  flavor.  From  the  frequency  of  the  vomit- 
ing she  had  become  much  emaciated.  The  catamenia  had  ceased  naturally 

-  before. 

1  I  use  the  word,  not  as  explaining  anything,  but  simply  to  fix  the  locality  of 
the  vital  act. 


154  ABDOMINAL    PAIXS. 

The  rest  of  the  hospital  and  well-prepared  food  stopped  the  sickness,  so 
that  we  saw  nothing  of  it  for  some  time ;  but  she  hud  several  attacks  of  water- 
brash  of  clear  alkaline  fluid.  Afterwards  the  vomiting  returned,  and  some- 
times was  mixed  with  the  pyrotic  fluid,  and  sometimes  contained  strings  of 
gastric  mucus. 

She  was  treated  at  first  with  this  pill — 

R. —  Pil.  Rhsei  comp.  gr.  v, 
Argenti  Nitratis  gr.  ±. 
Omni  nocte  et  mane. 

But  in  a  fortnight  she  felt  very  little  better.     She  then  took — 
R. — Ferri  Sesquioxidi  gr.  x, 

Bismuth!  Trisnitratis  9j,  ter  die. 
On  this  she  got  well  and  left  the  ward  on  September  4th. 

In  the  last  three  cases  it  will  be  observed  that  a  great  part  of 
the  motive  cause  of  the  illness  may  be  fairly  assigned  to  the 
innutritious  nature  of  the  patient's  diet.  Its  innutritiousness 
arises  principally  from  its  insolubility,  and  that  insolubility 
principally  from  bad  cookery.  But  yet  this  cause  was  not  suffi- 
cient to  produce  disease  in  a  healthy  body ;  there  was  alwavs 
superadded  some  depressing  influence  on  the  vitality,  of  either 
a  mental  or  physical  nature. 

This  is  to  be  noticed  even  in  the  waterbrash  of  the  Scotch 
oatmeal-eaters,  where  the  dietetic  cause  is  so  constantly  the 
same,  and  so  powerful  as  to  establish  the  disease  as  an  endemic. 

Dr.  Morgan,  of  Manchester,  who  formerly  practised  for  a 
short  time  extensively  in  the  Western  Highlands  and  Islands, 
in  a  letter  to  me  on  the  subject,  says — 

"  Cases  were  so  similar  in  their  leading  characteristics  that  after  seeing 
some  three  or  four  all  others  were  but  a  simple  repetition  of  symptoms.  The 
history  of  a  typical  case  was  something  of  this  kind.  From  some  cause  or 
other  the  vitality  of  the  system  in  an  oatmeal-eater  ivas  lowered.  Thereupon 
the  customary  diet,  whether  in  the  form  of  cake  or  porridge,  proved  a  source 
of  irritation  ;  the  patient  then  lost  flesh,  and  complained  of  a  sense  of  burn- 
ing heat  in  the  epigastrium  and  along  the  course  of  the  oesophagus.  Coin- 
cidently  with  these  symptoms  considerable  quantities  of  water  (a  pint  or 
more)  "  came  up"  rather  than  were  vomited.  .  .  .  Women  seem  to  suffer 
to  a  much  greater  extent  than  men." 

I  believe  the  same  is  the  case  still  more  strongly  with  the 
potato-nourished  peasantry  of  Ireland,  whose  more  sensitive 
nervous  system  renders  depressants  of  the  vitality  more  com- 
mon. But  I  have  no  written  records  of  the  fact. 


ABDOMINAL    PAINS.  155 

I>r.  Morgan  goes  on  to  attribute  the  innutritiousness  of  the 
diet  to  the  form  of  preparation  : — 

•  I  always  considered  that  the  eating  oatmeal  in  a  semi-cooked  state  had 
much  to  do  with  it.  As  it  rule,  the  people  do  not  sufficiently  boil  the 
porridge,  while  in  the  form  of  oat-cake  the  food  was  still  less  thoroughly  pre- 
pared. In  usiiiLr  an  oat-meal  diet  1  believe  that  it  is  very  important  to  carry 
tin-  cixikinir  sufficiently  far  to  lilienite  the  contents  of  thp  starch-granules. 
"Where  this  i<  not  done,  not  only  does  the  food  fail  to  nourish,  but  it  proves 
ric  irritation.  .  .  .  If  oat-meal  is  boiled  for  about  half  an 
hour  it  i».  even  though  coarsely  ground,  reduced  to  a  gelatinous  mass,  and  in 
this  fonn  it  is  comparatively  innocuous  so  far  as  existing  pyrosis  is  concerned 
— at  lea>t  such  is  my  experience." 

Seeing  the  importance  of  cookery,  the  occupation  of  the  next 
•at  ought  to  have  preserved  her  at  least  from  the  results  of 
bad  ait.     But  the  occupation  may  be  baneful,  as  well  as  its 
products. 

< '  V-K  ('XIV. — Elizabeth  P — ,  a  cook,  aged  26,  came  under  my  care  at  St. 
Mary's  July  30th,  1852,  for  pain  in  the  epigastrium,  increased  after  meals  and 
by  pr>  -lie  had  also  frequent  attacks  of  morning  waterbrash.  Her 

tc.ni.Mie  was  white,  but  otherwise  she  seemed  in  good  health;  the  catamenia 
and  the  evacuation  of  the  bowels  were  regular.  She  was  blistered  on  the 
scritliieulus  cordis,  and  took  fifteen  grains  of  Bismuth  three  times  a  day  and 
1'i-oth  diet.  On  the  Tth  of  August  she  was  well  enough  to  eat  a  mutton-chop. 
On  the  Hth  the  Bismuth  was  left  off.  as  the  local  symptoms  were  relieved; 
and  on  the  Isth.  there  being  no  return  of  waterbrash,  she  was  discharged. 

The  exposure  to  heat  involved  in  the  occupation  of  cook  pro- 
duces general  congestion  of  the  portal  system,  and  an  after- 
>sure  to  cold  draughts  inclines  to  a  catarrhal  condition  of 
-tomach.     Hence   arise  slow  digestion,  oppression  at  the 
epigastrium,   and  a  feeling  of  faintness,   which  often  leads  to 
dram-drinking.     A  further  stage,  more  certain  if  this  desire  for 
alcohol  be  indulged,  is  pain  immediately  after  food,  and  then 
pain  on  ] 

Observe  tin'  use  of  external  local  treatment.  That  was 
:t«-d  to  in  tin-  ea>«!  of  Klixabrth  1* —  because  there  was  pain 
on  pressure  as  well  as  after  nn-als.  The  pain  on  pressure  is  an 
evidence,  though  not  truly  an  absolute  proof,  of  the  existence  of 
anatomical  lesion,  cither  continuous  congestion  or  thickening 
or  uleeration.  And  1  find  that  where  it  exists  local  blistering 
does  good,  and  leeching  more  good.  Kveu  when  it  is  not  made 


156  ABDOMINAL    PAINS. 

out  in  a  clearly  defined  spot,  I  am  still  inclined  to  suspect  in 
waterbrash  such  a  condition  of  tissue  as  is  capable  of  being 
renewed  to  a  more  normal  one  by  the  alterative  action  of 
counter-irritants.  For  so  many  cases  occur,  like  those  which 
follow,  where  waterbrash  is  associated  with  indubitable  signs 
of  local  lesion. 

In  this,  for  instance,  there  was  not  only  the  peculiarity  of  the 
pain  running  backwards  to  the  spine,  but  also  a  blood-stain  in 
the  mucus  to  show  a  solution  of  continuity  in  the  capillary 
bloodvessels. 

CASE  CXV. — John  N — ,  a  painter,  but  without  any  signs  of  lead  poison 
exhibited  in  the  gums,  aged  35,  was  admitted  to  St.  Mary's  April  10th,  1855, 
suffering  from  waterbrash,  sometimes  of  a  sour  character,  and  sometimes 
alternating  with  vomiting  of  intensely  sour  greenish  liquid.  After  he  had 
been  in  the  ward  a  few  days  it  was  observed  that  the  vomit  contained  tawny 
mucus  like  that  expectorated  in  pneumonia,  and  sometimes  streaks  of  blood. 
He  had  also  pain  running  backwards  from  the  pit  of  the  stomach  to  a  spot 
between  the  shoulders,  which  pain  was  increased  by  pressure  of  the  finger  on 
the  cardiac  region.  When  he  was  at  his  worst  the  waterbrash  was  least 
marked,  but  still  it  was  a  feature  of  the  disease.  Pepsine  gave  no  relief. 
Hyposulphite  of  Soda  was  tried  without  benefit.  A  blister  to  the  epigas- 
trium made  him  better  for  a  couple  of  days  after  it,  but  he  then  relapsed. 
Most  advantage  seemed  gained  by  the  application  of  a  few  Leeches  to  the 
epigastrium.  He  became  an  out-patient  on  May  13th. 

In  the  next  the  blood  evidently  came  from  an  ulcer. 

CASE  CXVI. — Sarah  G — ,  aged  33,  a  housemaid,  was  admitted  at  St.  Mary's, 
under  my  care,  August  22d,  1857.  She  had  been  an  out-patient  with  un- 
accountable languor  and  anaemia,  which  was  at  last  detected  to  arise  from 
loss  of  blood  by  the  alimentary  canal.  After  admission  it  was  found  she  had 
also  waterbrash,  and  pain  on  pressure  of  the  pyloric  region.  And  then  the 
locality  of  the  injury  in  the  stomach  was  fixed  by  her  vomiting  blood,  both 
red  and  brown.  The  hemorrhage  was  stayed  by  means  of  Acetate  of  Lead 
and  Opium,  and  then  the  waterbrash  seems  to  have  got  worse.  It  was  con- 
siderably relieved  by  iced  milk  and  by  Bismuth,  but  more  by  a  blister.  A  grain 
and  a  half  of  Sulphate  of  Copper  daily,  which  was  given  for  a  fortnight, 
seemed  to  act  as  a  tonic  and  enable  her  to  digest  better,  quicker,  and  with 
less  pain.  She  was  still  taking  it  when  she  was  made  an  out-patient  October 
16th. 

It  does  not  appear  that  the  fluid  ejected  by  the  brash  was 
ever  bloody,  thus  showing  that  it  does  not  come  from  the  stomach, 
as  sometimes  represented,  but  from  the  oesophagus. 


ABDOMIXAL    PAIN'S.       .  157 

11  ••:•  tried  Sulphate  of  Copper  in  simple  waterbrash 

without  ha-::  >eneticial  action  in  this  case  would 

i  to  offer  an  encouragement  for  doing  so. 

In  tlu-  history  of  John  N —  (CASE  CXV)  it  is  mentioned  that 

painter.     Though  no  blue  lime  in  the  gums  denoted 

•nee  of  lead  in  the  body,  I  am  not  sure  that  we  can 

quit i-  acquit  that  subtle  poison  of  causing  the  disease.     In  the 

following  instance  the  accusation  was  brought  by  the  patient. 

V 1 1 . — M  r.  Kd win  S — ,  aged  30,  a  master  painter  and  glazier,  came 
July  Ttli.  1  -•;•_'.     He  suffered  from  excessive  waterbrash,  bringing  up 
-.mi's  upwards  of  two  pints  of  clear  fluid  in  the  course  of  the  night  and 
early  morning.    Sometimes  this  was  relieved  by  vomiting.  The  matters  vomited 
.it-id  and  frothy,  and  continued  to  ferment  and  swell  after  being  brought 
up.     1  had  no  opportunity  of  searching  them  for  s«/  riculi.     He  had 

also  often  heartburn  about  two  hours  after  eating.     His  tongue  was  unnatu- 
rally red  und  clean. 

Tin-si-  i-viN.  lie  said,  were  always  much  aggravated  by  anxiety  in  business, 
and  it  w;is  for  such  aggravation  that  he  consulted  me.  But  he  had  suffered 
in  the  stomach  more  or  less  from  boyhood,  when  he  used  to  work  with  lead 
paint. 

1  irave  him  half  a  drachm  of  Hyposulphite  of  Soda  daily,  and  fifteen  grains 
of  Uismiith  every  night.  In  a  few  days  with  the  medicine  and  rest  he  was 
better,  and  I  prescribed  some  Iron  next  with  Bismuth.  I  had  no  opportunity 
of  seeing  more  of  the  case,  as  his  family  doctor  did  not  send  him  again  to  me. 

The  Hyposulphite  of  Soda  was  administered  as  an  agent  to 
prevent  fermentation.  I  cannot  say  whether  it  was  effectual  or' 
not  in  this  case,  as  the  patient  did  not  vomit  afterwards;  but  I 
have  thought  in  others  that  it  seemed  to  effect  its  intended  pur- 
pose. That  purpose,  however,  must  be  well  understood  to  be  a 

limited  one,  for  it  does  not  cure  the  cause  of  the  fermenta- 
tion, namely,  the  slowness  of  digestion  which  retains  the  con- 

of  the  stomach  so  long  as  to  ferment  and  communicate 
their  fermentation  to  new  arrivals.     This  cure  must  be  efiV 
l>v  invigorating  the  vital  energy  of  the  failing  organ. 

The  violent  shock  to  the  vitality  of  the  mucous  membrane-; 
in  cholera  will  somet:  iiind  it  a  condition  of  stomach 

productive  of  waterlirash. 

'  >    \  VII  I.-  .Jo-t'j.h  W — .  a  laborer,  utr'-d  •!-.  admitted  to  St.   Man's 

October  'JTth.  1. -.VI.  had  gone  through  an  attack  of  choleraic  diarrhu  .1  .11 


158  .      ABDOMINAL    PAINS. 

August,  and  since  that  time  had  not  digested  his  food  properly.  The  epi- 
gastrium was  tumid  and  tympanitic  on  percussion.  The  tongue  was  large, 
flabby,  and  red,  as  if  flayed.  For  the  last  three  weeks  previous  to  admission 
he  had  suffered  from  attacks  of  waterbrash.  He  was  treated  with  gr.  xv  of 
Bismuth  three  times  a  day,  but  was  not  considered  ill  enough  to  remain  as  an 
in-patient  beyond  November  1st,  so  that  I  probably  saw  him  only  once. 

An  operating  cause  of  similar  nature  in  dysentery. 

CASE  CXIX. — Mr.  Henry  M — ,  a  man  of  middle  age,  had  several  attacks 
of  dysentery  in  Australia,  and  has  never  been  quite  strong  since.  He  suffers 
from  diarrhoea  from  the  slightest  error  in  diet.  It  was  one  of  those  attacks, 
brought  on  by  taking  a  cup  of  bad  coffee  at  a  coffee-shop,  that  induced  him 
to  consult  me.  I  gave  him  Sulphate  of  Copper  and  also  Bismuth,  which  both 
he  said  had  done  him  good  before.  On  inquiry  I  found  that  he  very  fre- 
quently suffered  from  waterbrash  in  the  morning  and  during  the  night,  though 
very  careful  of  his  diet.  He  traced  this  to  the  dysentery,  and  both  to  spirit- 
drinking,  which  he  felt  sure  predisposed  people  to  dysentery  in  Australia. 

It  is  also  sometimes  associated  with  phthisis  pulmonalis,  and 
then  the  defective  nutrition  which  it  implies  brings  on  a  con- 
dition of  general  degeneration.  This  is  important  from  the 
possibility  which  exists  of  staying  the  degenerative  tendency, 
and  so  arresting  the  downward  course  of  the  phthisis  by  atten- 
tion to  the  stomach  and  oesophagus. 

CASE  CXX. — William  J — ,  aged  21,  a  carpenter,  on  admission  to  St. 
Mary's,  August  21st,  1857,  was  much  emaciated,  and  presented  indubitable 
signs  of  solid  tubercle  in  the  upper  lobes  of  both  lungs,  of  such  duration  as  to 
have  made  the  upper  ribs  flat  and  immovable.  The  date  of  his  consumption, 
from  the  period  of  his  having  "  caught  cold"  and  spat  blood,  was  two  years. 
Latterly  he  had  suffered  from  waterbrash  of  a  morning.  It  was  difficult  to 
make  out  whether  he  had  pain  in  the  epigastrium,  as  there  was  stitch  in 
both  sides  of  the  waist,  which  had  its  origin  in  the  pulmonary  disorganiza- 
tion. 

After  a  few  days'  Cod-liver  oil  and  Iron  the  albumen  disappeared  from  the 
urine,  and  then  the  patient  began  to  gain  weight.  Between  the  28th  of  Au- 
gust and  September  the  5th  he  increased  2  lb.,  and  by  the  12th  1  Ib.  more. 
The  extent  of  further  increase  is  not  noted,  but  he  was  bettered  enough  to 
leave  the  hospital  on  October  3d. 

The  disappearance  of  the  albumen  from  the  urine  shows  that 
the  derangement  of  the  kidneys  was  only  temporary.  But  in 
pulmonary  consumption  we  find  such  temporary  derangements 
soon  end  in  permanent  disorganization,  if  allowed  to  become 
ingrained. 


ABDOMINAL    PAIXS.  159 

It  may  he  observed  that  in  several  previously  quoted  exam- 

the  supervention  of  waterbrash  has  been  at  the  period  of 

the  normal  cessation  of  the  catamenia.     It  is  also  apt  to  follow 

upon  such  states  of  body  as  cause  the  arrest  of  the  periodical 

nation  in  younger  women. 

In  the  following  case  there  was  also  joined  an  occupation 
which,  as  we  have  seen,  tends  to  produce  derangements  of  the 
upper  organs  of  digestion. 

XI.— Kllen  R— ,  a  cook,  aged  82,  admitted  to  St.  Mary's  Novem- 
ber 4th,  l>.'ii'i.  had  been  -retimi:  ill  frradually  Tor  some  months,  at  first  suffer- 
ing from  feverishness.  headache,  and  constipation,  then  finding  her  monthly 
I,  though  --In1  >till  had  leucorrhoea  and  pain  in  the  back  at  the 
time  when  they  oiiL'ht  to  appear.  The.  last-arrived  symptoms  were  a  drib- 
bling of  saliva  from  the  mouth,  and  on  rising  in  the  morning  a  gush  of  clear 
watery  fluid  from  the  oesophagus.  This  fluid  was  sometimes  made  acid  by  the 
admixture  with  it  of  some  of  the  contents  of  the  stomach  ejected  by  vomit- 
ing. She  once  also,  while  in  hospital,  threw  up  some  greenish  fluid  (?  altered 
blood). 

Hie  was  treated  with  Bismuth  and  ultimately  discharged  well. 

Green  vomit  may  arise  from  the  admixture  of  bile  which  has 
regurgitated  through  the  pylorus.  This  only  happens  after 
violent  retching  and  straining,  and  the  bile  may  be  recognized 
1 1\  its  bitter  taste.  It  may  also  arise  from  the  admixture  of  blood 
altered  by  the  gastric  juice  like  the  porraceous  stools  of  dysen- 
.  and  in  such  case  there  is  likely  to  be  very  little 
straining  and  no  bitter  taste.  The  notes  are  not  full  enough  to 
decide  of  which  nature  Ellen  R — 's  vomiting  was,  probably  the 
latter,  as  bilious  vomit  is  rarely  joined  to  waterbrash.  Indeed, 
bile  is  seldom  thrown  up  in  chronic  diseases,  and  appears  rather 
a  guarantee  of  a  considerable  amount  of  health. 

In  nearly  all  the  cases  I  have  quoted  waterbrash  has  occurred 

in  young  or   middle-aged  persons.     And  perhaps  this   fairly 

represents  the  habits  of  the  disease.     Yet  it  is  not  unknown  in 

the  old,  as  the  following  instances  will  show,  an<l  show  also  that 

•  •ure  is  not  to  be  despaired  of  even  in  them. 

1  -•••:(  'XXII. —  In  May,  1M-.  II--.  a  fanner.  came  under  my  care  for 
wateilira-h.  from  which  In-  had  lately  be»un  tu  sutler.  He  had  u\«>  occasional 
attacks  i.f  vomitiiiir.  1 1  I  almut  70.  He  i;»t  well  on  Hismuth.  I 

saw  him  again  in  lt»51,  for  some  j»aiu  in  the  pyloric  region  of  the  stomach 


160  ABDOMINAL    PAIXS. 

without  waterbrash.     However,  there  was  no  cancer,  for  I  recollect  seeing 
him  several  years  afterwards  in  the  streets  at  the  time  of  the  cattle-show. 

CASE  CXXI1L—  Mrs.  B  —  ,  aged  66,  was  under  my  care  in  July,  1861,  for 
waterbrash.  accompanying  indigestion  brought  on  by  anxiety  of  mind  in  nurs- 
ing a  consumptive  son-in-law. 

CASE  CXXIV.  —  Mrs.  A  —  ,  aged  60  (but  older  than  her  age  reckoned  by 
annual  revolutions  of  the  sun,  for  the  catamenia  had  ceased  eighteen  years), 
consulted  me  in  August,  1863,  for  indigestion,  marked  by  waterbrash  occur- 
ring at  various  times  of  the  day,  not  confined  to  the  morning. 

CASE  CXXV.  —  Mr.  Thomas  S  —  ,  aged  72,  was  sent  to  me  by  Dr.  Ellison, 
of  Windsor,  January  26th,  1867,  respecting  severe  pyrosis  which  had  on  the 
present  occasion  afflicted  him  upwards  of  six  weeks.  It  occurred  daily,  and 
was  getting  worse  ;  he  had  several  times  brought  up  as  much  as  two  and  a 
half  pints  in  twenty-four  hours.  The  sensation  was  described  as  of  something 
working  in  the  right  side  of  the  epigastrium,  and  then  there  was  suddenly  and 
forcibly  ejected  a  great  jet  of  liquid.  It  was  almost  always  quite  clear  and 
tasteless,  and  resembling  saliva  in  appearance.  There  was  often  pain  at  the 
cardiac  extremity  of  the  stomach  half  an  hour  before  the  supervention  of  the 
brash,  by  which  it  is  alleviated. 

Mr.  S.  was  a  robust  man  of  rubicund  healthy  appearance,  but  he  said  he 
had  been  subject  for  more  than  a  quarter  of  a  century  to  this  waterbrash 
from  time  to  time;  never,  however,  so  bad  as  during  December  and  the  Janu- 
ary when  he  came  under  my  care. 

I  desired  him  to  come  again  on  the  30th,  and  to  bring  with  him  some  of 
the  pyrotic  fluid  collected.     In  the  mean  time  I  prescribed  — 
R.  —  Quiniae  Sulphatis  gr.  iss, 

Strychnia?  Hydrochloratis  gr.  5\j, 
Succi  Limonum  q.  s.  ad  ilia  solvenda, 
Aqua  ad  fl^viiss, 
Sps.  Bosmarini  fl^ss, 

ter  die  sumendus. 

On  the  appointed  day  he  returned,  but  without  the  expected  morbid  speci- 
men. During  the  first  thirty-six  hours  he  brougMTup  a  good  deal,  and  he 
thought  there  would  be  time  enough  to  collect  it  afterwards.  But  after  the 
fifth  dose  of  the  medicine  a  great  explosion  of  flatus  occurred,  and  continued 
for  several  hours.  Since  then  his  disease  had  quite  disappeared. 

I  hear  to-day  (April  3d)  from  his  son-in-law  that  MrisS  —  has  continued 
quite  well.  He  has  continued  taking  the  medicine  irregularly  from  time  to 
time  since  I  saw  him.  So  I  say  I  think  he  has  had  quite  enough  of  it. 

The  following  case,  on  the  other  hand,  is  exceptional  from  the 
youth  of  the  patient. 


CXXVI.  —  Miss  S  —  ,  aged  15,  an  undergrown  girl,  was  in  my  hands 
in  July,  1858,  for  waterbrash  accompanied  by  a  feeling  of  oppression  at  the 


ABDOMINAL    PAINS.  161 

-'riiim  occurring  when  the  stomach  was  empty,  and  relieved  1»y  meals. 
Sh>-  was  weakly,  and  retained  the  insignia  of  former  ill-health  in  the  shape  of 
scrofulous  scars  in  the  neck. 

In  this  last  example  mention  is  made  of  the  relief  which  some 

us   aftected  by   waterbrash   experience  on   taking  food. 

Tliis  so  frequently  occurs  in  heartburn,  and  so  rarely  in  ulcera- 

tion,  that  I  am  disposed  to  view  it  as  an  evidence  that  the 

-h  does  not,  where  it  is  found,  depend  on  any  serious 

anatomical  alteration  of  tissue. 

I  have  never  seen  it  amount  to  "bulimia."  The  patients 
went  to  eat  often,  but  they  are  not  often  hungry,  and  they  do 
nut  want  to  eat  much.  I  cannot  recognize  the  truth  of  the  ' 

it-lit  made  by  some  writers,  that  indigestion  leads  to  buli- 
mia, as  I  understand  the  term. 

It  is  a  relief  which  may  be  prudently  allowed  to  them,  so  that 
care  be  taken  that  what  is  eaten  be  easily  digestible.  Indeed, 
a  judicious  management  may  turn  it  to  a  means  of  cure  by 
preventing  the  overloading  of  the  stomach — by  "spoiling  the 
meals,"  as  it  is  technically  called. 


The  treatment  of  waterbrash  has  been  almost  sufficiently  de- 
tailed in  the  histories  given.  It  consists  of  sedative  alkalies, 
and  the  best  are  those  which  lie  longest  undissolved,  such  as 
Nitrate  of  Bismuth.  I  give  this  in  doses  of  from  ten  grains  to 
half  a  drachm,  either  alone  in  a  powder,  or  in  a  draught  with 
Carbonate  of  Soda  and  Hydrocyanic  Acid.  The  Soda  I  give 
where  there  is  much  acid  rising,  the  Hydrocyanic  Acid  where 
there  is  local  pain  on' swallowing  or  on  pressure. 

In  the  robust  ancient  described  in  Case  CX  XV  it  will  be  seen 
that  Quinine  and  Strychnine  um-xpeetedly  alone  effected  a  cure. 
They  should  tin-ret'ore  not  be  omitted  as  part  of  the  treatment 
at  le. 

Iron  is  useful  in  ana-mi.-  The  red  rust  goes  very  \ 

in   a    powder  with   the  Bismuth,  and   may    perhaps  render  anv 
other  tonic  superfluous. 

KinO  And  Opium  powder  is  also  a  good  astringent  to  the  upper 
part  of  the  prima  1  hardens  the  over-sensitive  ner\ 

11 


162  ABDOMINAL    PAINS. 

the  oesophagus,  but  I  cannot  lay  hand  on  any  cases  in  which  I 
have  used  it  alone. 

The  local  application  of  Leeches  and  Blisters  must  depend  on 
our  diagnosis.  They  are  of  use  in  those  numerous  instances 
where  there  is  pain  on  pressure  elicited  by  the  finger  rather  than 
the  palm  of  the  hand — not  otherwise,  I  think.  The  water-cure 
by  compresses  usually  does  harm;  it  renders  the  part  more 
sensitive,  and  the  local  application  of  cold  is  too  depressing. 

In  food  all  insoluble  matters  (such  as  those  consisting  chiefly 
of  cellulose,  chlorophyll,  and  raw  starch),  waxy  potatoes,  peas 
and  beans,  cucumbers,  sodden  pastry,  new  bread,  half-cooked 
porridge  (according  to  Dr.  Morgan  in  the  letter  quoted  page 
155),  and  the  like,  must  be  avoided.  Fresh  meat- broth,  beef- 
tea,  milk  guarded  with  lime-water,  must  be  the  food  trusted  to. 
I  have  found  raw  oysters  well  borne ;  but  they  must  be  quite 
fresh  and  well  chewed. 

SECTION   IV. 

Spasms, 

or  "  The  Spasms,"  or  "Stomach-ache,"  as  sometimes  called,  is  a 
peculiar  pain,  resembling  that  felt  in  cramp  of  the  voluntary 
muscles,  extending  across  the  epigastrium.  It  remits  from 
time  to  time,  but  does  not  intermit  like  heartburn.  Though 
the  pain  resembles  that  of  cramp,  there  is  no  evidence  of  any 
muscular  contraction ;  indeed,  examination  of  the  epigastrium 
shows  the  stomach  distended  with  a  more  than  ordinary  amount 
of  solid  matter  and  air.  This  pain  arises  in  a  stomach  rendered 
atonic,  either  temporarily  by  some  depressing  agent,  such  as 
heat  or  fatigue,  or  more  permanently  by  general  debility,  when 
the  organ  is  filled  with  some  insoluble  matters.  It  is  a  con- 
dition analogous  to  the  over-distension  of  the  bladder  with 
retained  urine,  in  which  the  pain  has  a  similar  remittent 
character.  It  usually  commences  from  five  to  six  hours  after 
the  food  which  has  produced  it,  becomes  gradually  more  intense, 
and  passes  oft'  either  by  the  insoluble  mass  getting  through  the 
pylorus  or  by  vomiting. 

The  seat  of  the  pain  is  not  easy  to  fix  when  it  is  severe.  In 
the  lighter  cases,  and  as  it  passes  away,  it  seems  to  tend  towards 


ABDOMINAL    PAINS.  163 

tlic  ].yl<>ri.-  s|«hinri.>r.  and  to  become  located  there.     The  very 

•'ilar  nature  of  that  part  may  serve  to  explain  the  tendency 

of  this,  more  than  any  other  gastric  pain,  to  be  associated  with 

\B  of  voluntary  muscles. 

Other  characteristics  will  be  sketched  in  the  cases  which 
follow. 

i  XXVII. — In  the  summer  of  1842  the  writer  started,  without  his 
breakfast,  curly  in  a  row  boat  from  the  top  of  the  Lago  di  Como.  He  was 
out  in  the  sun  without  food  till  noon,  when  he  bought  his  hatful  of  hard 
:,es  and  littlf  green  figs,  and  finished  them  at  a  sitting.  In  the  afternoon 
]i:tiu  across  the  epigu.-triurn  gradually  came  on,  but  still  he  ate  his  dinner. 
That  seemed  to  ea>c  the  pain  for  a  time,  but  it  came  on  again  worse  and 
in  paroxysms,  just  like  cramp.  He  travelled  on  in  an  open  carriage 
from  Coino  to  Milan,  but  the  pain  was  very  bad.  On  the  road  he  vomited, 
not  his  dinner,  but  the  skins  of  the  figs  and  the  peaches  in  the  state  in  which 
they  were  swallowed.  After  arriving  at  Milan  at  midnight  he  vomited  again, 
this  time  the  dinner  eaten  in  the  afternoon.  The  masses  of  food  had  therefore 
got  reversed  in  their  position  in  the  stomach.  Soon  after  the  second  vomiting 
the  spasmodic  pains  abated  and  ceased  with  sleep. 

\  V  1 1 1. — The  same  party  in  the  following  year  lunched  on  a  dozen 
or  so  of  pears  at  l.eipsic  after  a  hot  dusty  journey  from  Dresden.  Again  the 
pain  was  relieved  by  dinner,  but  returned  afterwards.  An  emetic  of  mustard- 
and-wuter  gave  relief  rather  sooner  than  waiting  for  the  spontaneous  evacua- 
tion of  the  stomach. 

CASK  (  X  X  1  X. — The  same  party,  when  not  in  very  strong  health  this  spring, 
committed  the  imprudence  of  seeing  a  troublesome  patient  before  breakfast. 
At  noon  pain  in  the  epigastrium  came  on,  was  relieved  by  a  mutton-chop  at 
lunch,  returned  worse  an  hour  afterwards.  In  the  evening  vomiting  was  in- 
duced, and  the  first  things  that  came  up  were  the  toast  and  water-cress  eaten 
at  break fa.-t.  With  >li-ep  the  attack  passed  off,  but  the  epigastrium  still 
remained  abnormally  tumid  and  resonant  on  percussion. 

I  promised  in  a  former  chapter  (page  97)  to  introduce  another 
case  in  which  gluttony  was  an  act  of  virtue,  if  not  of  heroism — 
it  i.s. 

CASK  ('XXX.— Mrs.  D — ,  aged  50,  sent  for  me  one  afternoon  this  spring  of 

'(i  .-re  I),  r  a  few  iii.l.-s  down  the  rouiitry.     1  found  her  .-lowly  Meot 
from   an   attack   of  "spasms  of  the   .  li--t  '    M-pi-.ra>triuin),   which   had   la.-ted 
twenty-tour  hours.  leawni:  the  epiira-trium  tumid  and  druinmy  on  pen  i, 
Slie  had  pas.-ed  one  small  li»ht-mlored  pultaceous  stool,  so  I  gave  h«  r  a 
Hhuburb  and  Peppermint  draught  to  elicit  another  or  two. 

I  directed  my  principal  attention  to  discover  the  exciting  cause  of  the 
stomach-ai-lie.  and  believed  that  1  riirhtly  fixed  on  a  lar^e  cold  curly  dinner, 


164:  ABDOMINAL    PAIXS. 

accompanied  by  a  quantity  of  salad  and  cucumber.  I  gave  a  warning  against 
tfyis,  and  then  went  to  the  village  hard  by  to  see  an  old  patient,  a  poor  cousin 
of  the  one  who  had  summoned  me,  making  my  visit  to  the  wealthy  relative  an 
excuse  for  not  taking  a  fee. 

A  short  time  afterwards  I  received  a  second  summons;  found  Mrs.  D —  had 
another  attack  of  spasms,  had  vomited,  and  was  better.  But  what  was  my 
surprise  to  see  in  the  basin  a  large  quantity  of  cucumber,  against  which  I 
had  given  such  a  strong  warning.  I  found  reason  for  believing  that  this 
apparent  act  of  gluttony  was  committed  as  an  excuse  for  getting  me  to  see 
the  less  fortunate  neighbor  again.  The  vomiting  made  the  attack  pass  over 
quicker  than  the  former  one,  and  no  purgative  was  required.  The  contents 
of  the  basin  were  very  slightly  acid. 

Mark  the  last  sentence — it  is  clearly  not  acid,  but  distension, 
that  causes  these  pains. 

The  preceding  cases  have  exhibited  spasms  arising  after  a 
heavy  meal  of  insoluble  matters  taken  at  an  unnatural  hour. 
When  the  atony  or  paralysis  is  induced  by  dinner,  then  the 
attack  assumes  a  different  and  to  the  patient  a  more  alarming 
character.  He  is  woke  up  by  it  in  the  early  morning,  and  I 
think  it  is  usually  more  sharp  and  severe. 

CASE  CXXXI. — E.  N.  S — ,  an  energetic  but  not  strong  business-man  of 
middle  age,  has  had  several  of  these  morning  attacks,  which  he  can  always 
trace  to  a  dinner  of  insoluble  matters  after  an  anxious  day's  work.  He  is 
always  a  good  deal  alarmed  at  the  time,  but  they  pass  off  in  the  course  of 
the  forenoon,  either  by  vomiting  or  pultaceous  stools.  The  matters  vomited 
I  have  never  seen,  but  he  says  they  retain  the  taste  of  food,  and  are  not  acid 
or  fermenting. 

In  whatever  parts  it  may  occur,  atony,  or  defect  of  voluntary 
and  normal  action,  has  a  tendency  to  alternate  with  involuntary 
and  abnormal  action.  It  is  when  the  legs  are  tired  with  over- 
walking  that  they  are  apt  to  be  racked  with  cramp ;  it  is  when 
the  whole  body  is  debilitated  and  incapable  of  designed  control 
that  it  is  agitated  by  chorea. 

The  atony  of  purely  involuntary  parts  most  generally  pro- 
duces these  contractions,  not  in  themselves,  but  in  the  neigh- 
boring systems  of  muscles,  subservient  in  most  cases  to  the 
concatenated  acts  of  the  said  involuntary  parts.  Thus,  over- 
distension  of  the  bladder  causes  stricture  in  the  urethra ;  over- 
hard  and  bulky  feces  bind  up  the  sphincter  ani. 

I  have  already  pointed  out  how  chronic  slowness  of  gastric 


ABDOMINAL    PAIX3.  165 

digestion  first  is  evidenced  by  heartburn,  which  appears  to  be 
relaxation,  and  then  by  waterbrash,  dependent  on  contraction 
of  the  oesophagus. 

Ju.st  so  acute  atony  of  the  stomach,  or  stomach-ache,  will 
sometimes  produce  cramps  of  the  abdominal  parietes,  even  while 
it  is  it.-elf  distended  and  palsied. 

CASK  < 'XX XII. — At  the  end  of  last  June  I  was  requested  by  Mr.  Paget 
•  a  young  man  of  nineteen,  reported  to  have  cholera.     The  history  I 
found  to  be  this.     He  had  been  working  hard  at  inorganic  chemistry,  to  pre- 
pare fur  :ni  examination,  torturing  the  metals  and  himself  with  repeated  tests, 
in  it  shrinking  from  exposure  to  Sulphuretted  Hydrogen,  and,  what  was  still 
worse,  not  carinir  if  tin-  laboratory  stank  of  Arsenic.     Then  came  the  exami- 
:i.     The  evening  before  it  he  came  home  tired  and  anxious,  but  ate  a 
good  dinner,  probably  with  the  false  appetite  of  intellectual  toil.     He  went 
!•>  li.-il  and  to  sleep,  but  was  awoke  before  sunrise  by  a  spasmodic  pain  in  the 
epigastrium,  not  increased  but  rather  lightened  by  pressure.     As  this  got 

lie  tried  to  ease  it  by  forcing  an  action  of  the  bowels,  but  his  su 
brought  no  relief  to  the  pain.  Breakfast  made  him  somewhat  better,  and  he 
went  to  the  laboratory.  But  by  eleven  o'clock  he  got  so  bad  that  he  was 
home  and  went  to  bed.  In  the  afternoon  cramps  came  on  in  the  abdo- 
minal parietes,  and  could  be  alleviated  only  by  the  constant  rubbing^of  two 
sturdy  housemaids.  These  cramps  extended  from  time  to  time  into  the  legs 
and  arms.  The  epigastrium  was  tumid  and  drummy  on  percussion.  His 
face  was  shrunken,  pale,  and  livid,  the  eyes  leaden  and  anxious,  the  pulse 
small  and  extraordinarily  quick  (nearly  140  in  a  minute),  the  skin  cold  and 
clammy.  Indeed,  I  did  not  wonder  at  the  household  calling  it  cholera.  But 
I  was  comforted  by  finding  no  vomiting  or  diarrhoea,  and  by  seeing  a  fair 
quantity  of  full-colored  urine  in  the  chamber  utensil.  Towards  sundown  the 
pain  gradually  abated ;  he  had  a  pultaceous  stool,  went  to  sleep,  and  when  I 
saw  him  again  the  next  morning  was  well,  though  he  said  his  belly  was  very 
sore  after  the  cramps.  The  pulse  had  sank  to  80. 

These  cramps  have,  I  suppose,  the  same  pathology  as  those 

\vhieh  so  general  I  v  accompany  the  collapse  of  cholera.  In  that 
disease  they  art;  ilt-veloped  in  e"ii-«-.|iience  of  the  whole  alimen- 
'  anal,  but  more  especially  the  ilia,  being  devitalised  and 
paralyzed  l»y  an  extraneous  poison  ;  whereas  here  the  stretch  in  g 
of  the  stomach  by  the  overpowering  weight  of  a  mass,  which  it 
cannot  move  on,  is  the  paralyzing  agency. 

In  the  ease  eit.-<l  above  possibly  the  Sulphur  and  Arsenic 
may  have  had  somewhat  to  <!<>  with  the  illness,  but  their  sp 

>nous  actions  were  not  in  any  way  manil'este'l  in  the  >ymp- 
toma. 


166  ABDOMINAL    PAINS. 

Spasmodic  pain  will  sometimes  in  weakly  and  elderly  persons 
be  a  consequence  or  an  accompaniment  of  flatulence.  At  least 
the  pain  resembles  spasmodic  pain,  and  moves  about  from  one 
part  of  the  abdomen  to  another,  not  being  usually  fixed  in  the 
stomach  like  that  described  above.  It  may  be  easily  relieved 
by  a  diffusible  treatment  at  the  moment,  but  care  must  be  taken 
lest  a  habit  of  dram-drinking  be  thus  encouraged,  for  in  good 
truth  it  is  often  among  those  who  are  too  much  inclined  that 
way  that  periodical  spasms  occur.  I  therefore  prefer  to  order 
an  officinal  draught  to  the  vague  recommendation  of  a  glass  of 
spirits  when  they  feel  bad,  as  medical  men  often  do.  The 
strengthening  of  the  stomach  by  nerve-tonics  is  the  best  cure. 

CASE  CXXXIII. — An  old  man-of-war's-man,  turned  wine  merchant,  was 
sent  to  me  by  Mr.  Way,  of  Portsea,  Feb.  20,  1867,  on  account  of  spasmodic 
pains,  which  occurred  from  time  to  time  in  the  epigastrium.  There  was  no 
pain  to  be  produced  by  pressure  on  the  affected  part,  and  indeed,  "  when  the 
spasms  are  on,"  pressure  palliates  them,  he  said,  and  he  lies  with  his  stomach 
firmly  driven  against  the  edge  of  a  table  or  chair  with  considerable  relief  for 
a  long  time  together.  They  always  pass  away  with  a  great  explosion  of  wind. 
Bad  attacks  of  these  spasms  came  on  about  once  a  week,  but  he  had  often 
slighter  paroxysms  at  night  between  times.  He  had  fallen  away  in  flesh  a 
good  deal,  and  the  lips  had  grown  paler,  and  the  cheeks  patchy  in  color;  his 
tongue  was  pale,  wet,  and  smooth  ;  his  bowels  were  open  daily ;  the  urine  was 
pale,  acid,  of  the  specific  gravity  1.015,  not  albuminous. 

His  habits  hare  been  usually  active,  as  he  is  fond  of  shooting  and  sea- 
fishing,  and  has  opportunities  of  indulging  his  tastes.  His  worst  habit  seems 
to  be  that  of  occasional  schnaps  of  spirits  in  the  evening,  but  he  cannot  be 
called  an  intemperate  man. 

He  was  ordered  two  grains  of  Quinine  and  2's  of  a  grain  of  Strychnine  dis- 
solved in  lemon  juice  twice  a  day,  and  told  to  eat  as  much  flesh  meat  as  he 
could  find  an  appetite  for,  and  to  abstain  from  spirituous  liquors. 

I  also  told  his  wife  to  have  ready  for  him  in  case  of  an  attack  of  spasms  as 
much  Bicarbonate  of  Soda  as  will  lie  on  a  florin,  the  same  quantity  of  Mag- 
nesia, a  teaspoonful  of  Sal  Volatile,  and  ten  drops  of  Laudanum. 

A  close  resemblance  to  the  pain  above  described  is  sometimes 
found  as  a  manifestation  of  malarious  poison.  These  cases  may 
usually  be  distinguished  by  the  entire  absence  of  all  other  gastric 
derangement,  or  the  indication  of  any  such  derangement  in  the 
general  health,  by  the  intermission  of  the  pain  and  its  entir'e 
absence  during  the  intervals,  or  by  the  previous  presence  of 
other  proofs  of  ague  poison.  The  following  is  an  example:— r- 


ABDOMINAL    PAINS.  167 

I  \\IV.-In  Nov.-ml.rr.  1*:«7,  I  was  consulted  by  Mr.  J.  W.  W— , 
a  young-looking  man  of  40.  concerning  the  occurrence  at  intervals,  sometime* 
regular  ami  sometimes  irreirular,  of  a  violent  "spasmodic  pain,"  as  he  called 
it.  in  the  epigastrium.  Its  usual  time  of  invasion  was  between  three  and  four 
o'<  l"ck  in  the  morning,  after  goinj;  to  bed  in  perfect  health.  It  would  last  an 
hour  or  two.  and  then  cease  with  the  eruption  of  considerable  sweating.  It 
was  worse  towards  the  right  side  of  the  epigastrium.  His  tongue  was  clean, 
and  he  had  habitually  two  natural  solid  stools  a  day.  He  had  never  had  ague, 
but  his  house  was  buried  in  tall  trees  in  a  damp  valley  in  the  west  of  Shrop- 
shire, and  even  he  allowed  it  to  he  ill-drained.  One  of  his  children  had  died 
of  low  fever.  He  had  just  had  a  more  than  ordinary  severe  attack  of  spa-ins 
during  a  night  journey  by  rail.  His  aspect,  however,  was  that  of  perfect 
health,  and  there  was  not  a  trace  of  tenderness  in  the  abdomen. 

I  desired  him  to  take  two  grains  of  Quinine  in  a  little  whiskey  twice  a  day 
for  three  weeks  at  once,  and  in  future  to  take  the  same  course  for  a  week 
whenever  he  returned  home  from  a  temporary  absence. 

Karly  in  1858  he  came  to  report  that  the  treatment  was  completely  success- 
ful, though  he  had  in  the  meanwhile  broken  an  arm;  and  later  in  the  year  I 
had  a  message  to  the  same  effect 

It  is  characteristic  of  this  neuralgic  pain  that  it  is  not  de- 
veloped by  external  pressure  or  by  food,  and  that  there  is  no 
tenderness  of  the  epigastrium.  By  this  it  is  distinguished  from 
a  kind  of  spasmodic  pain  by  which  the  wearing  pain  of  ulcer  is 
sometimes  diversified. 

I  would  always  give  the  Quinine  without  acid  in  these  cases, 
for  it  is  wanted  to  act  directly  on  the  nerves  of  .the  alimentary 
canal. 

SECTION   V. 
Gripes. 

Sometimes,  instead  of  the  pain  caused  by  food  remaining  in 

the  t.-pi^astrium,  or  extending  upwards  towards  the  fauces,  it 

•nds  to  the  lower  bowels  and  is  felt  as  a  twisting  sensation 

about  the  umbilical  and  hypoirastric  regions.     This  is  usually 

followed  and  ended  by  the  passage  of  one  or  two  light,  loose, 

i  frothy  stools,  in  which  may  be  not  seldom  detected  articles 

of  diet  swallowed  scarce  half  an  hour  before. 

Patients  do  not  call  this  "diarrhosa,"  for  it  is  excited  only 
by  lood,  and  MM68   inini.-diat«-l y    with   the  evacuation.     '! 
usually  describe  it  Bi  -.''     One  gentleman,  who  had 


168  ABDOMINAL    PAIXS. 

been  reading  the  ancients,  denominated  it  "  lientery,"  and  I 
dare  say  it  is  what  our  forefathers  in  art  meant  by  that  word. 

It  will  be  seen  by  the  cases  used  for  illustration  that  it  is 
usually  dependent  upon  some  morbid  condition  of  the  lower 
bowels,  either  the  last  part  of  the  ilium  or  the  colon.  Why  a 
lesion  in  that  situation  should  cause  the  contents  of  the  stomach 
to  pass  through  the  pylorus  too  rapidly,  when  lesions  of  the 
stomach  itself,  duodenum,  liver  or  jejunum,  do  not  do  so, 
though  much  nearer,  is  not  explained. 

The  following  example  presents  that  which  is  the  most  un- 
fortunately common  shape  in  which  this  ailment  is  found  : — 

CASE  CXXXV. — On  September  29th,  1857,  I  was  consulted  about  a  lady, 
aged  45,  who  complained  that  immediately  after  taking  food  a  pain  came  on 
in  the  centre  of  the  epigastrium,  which  gradually  proceeded  downwards  with 
a  twisting  wavy  movement,  till  within  half  an  hour  it  ended  in  a  motion  of 
the  consistence  of  pea-soup,  which  varied  in  appearance  according  to  the 
nature  of  the  food  it  followed,  and  often  smelt  of  that  food  in  case  of  its  hav- 
ing any  characteristic  odor.  There  was  no  pain  on  pressure  at  the  epigastrium, 
but  in  the  right  iliac  fossa  there  was.  Ulceration  probably  existed  in  that 
locality;  and  the  scars  of  juvenile  abscesses  in  the  throat,  together  with  con- 
solidation of  the  two  apices  of  the  lungs,  made  almost  certain  the  conclusion 
that  they  were  of  a  tuberculous  character.  Sulphate  of  Copper,  Morphia, 
Logwood,  and  Bismuth,  were  tried  in  succession,  with  only  the  merest  tem- 
porary advantage. .  She  soon  afterwards  died. 

In  mentioning  this  fatal  termination  of  tubercular  ulceration 
of  the  digestive  canal,  I  do  not  mean  to  imply  that  such  is  the 
necessary  history  of  every  case.  CASE  XLII  is  an  instance  to 
the  contrary;  but  I  do  not  find  any  mention  there  of  the  griping 
and  emptying  of  the  stomach  immediately  after  the  meals,  as 
in  Mrs.  B — .  And  this  I  have  generally  found  an  omen  of  very 
bad  import.  In  point  of  fact,  it  is  not  so  much  the  diarrhoea  as 
the  effect  of  that  diarrhoea  upon  the  upper  part  of  the  digestive 
canal,  especially  upon  the  stomach,  which  proves  so  deadly. 

CASE  XLII  shows  that  it  is  very  wrong,  when  tubercular 
disease  of  the  lung  exists,  to  despair  of  effecting  a  cure  of  the 
diarrhoea  existing  alone ;  but  I  must  say  I  have  never  come 
across  a  case  of  a  favorable  termination  in  consumptive  cases 
where  the  upper  regions  of  the  primae  vise  were  affected  by  it. 


ABDOMINAL    PAIXS. 

However,  in  non-consumptive  cases  much  more  may  be  done 
in  spite  of  the  gastric  complication. 

OAOI  TXXXVI.  -  In  September,  is:.*,  \V.  .7—  pnt  himself  under  my  care. 
His  age  was  f)0.  He  had  lived  an  active  business  life  without  any  severe  ill- 
ness. But  for  the  last  three  years  or  more  he  had  become  affected  on  the 
slightest  provocation  with  looseness  of  bowels.  This  had  gradually  become 
constant,  a  pain  coming  in  the  epigastrium  immediately  after  food  and  ending 
in  a  motion.  Examination  of  the  chest  detected  no  lesion  of  the  lungs. 

I  managed  to  check  this  with  small  doses  of  Castor-oil  and  Opium,  and 
extract  of  Hajmatoxylum.  But  it  recurred  again  in  December,  and  then  I  found 
there  was  pus  and  streaks  of  red  blood  in  the  stools,  and  gave  him  Sulphate 
«>f  Topper.  This  was  soon  effectual.  In  February,  1861,  it  again  returned 
gradually,  and  I  give  him  Bismuth  for  a  month,  but  it  did  not  stay  the  symp- 
toms, and  we  were  obliged  to  have  recourse  to  his  old  friend  Sulphate  of 
Copper,  which  set  him  up  again.  In  18(»3  he  came  to  consult  me  about  a 
couuh.  but  made  no  further  complaint  of  loose  bowels  or  epigastric  griping. 

The  streaks  of  red  blood  in  the  stools  render  it  most  probable 
that  the  lesion  was  in  the  colon,  and  the  absence  of  any  com- 
plaint of  pain  in  the  ilio-caecal  region  confirms  the  diagnosis. 

I  am  convinced  Sulphate  of  Copper  is  the  most  effectual 
remedy  in  these  cases.  Next  to  it  comes  Ilcematoxylum,  and 
next  Opium.  So  far  as  immediate  effects  are  concerned,  perhaps 
Opium  should  rank  higher,  but  the  good  it  does  is  by  no  means 
permanent. 

By  beginning  with  {-grain  doses,  Sulphate  of  Copper  may  be 
carried  to  two  grains  with  safety. 

The  annexed  case  gives  a  detailed  history  of  the  origin  of  the 
ili>«-;ise  in  non-tubercular  persons. 

CUa  T  X  X  X  VII.— J.  B.  C — ,  17  years  of  age,  had  a  severe  acute  diarrhoea, 
brouirht  on  by  the  eflluvium  from  an  offensive  drain  in  the  house  where  he 
was  at  school.  This  was  in  1858.  From  that  time  he  became  subject  to  fre- 
quent attacks  of  diarrhcra,  brought  on  by  very  slight  causes,  and  especially 
in  . I uiie.  iM'il.  had  one  when  at  college,  which  was  dysenteric,  that  is,  accom- 
panied by  sanguineous  stools.  After  this  his  meals  brought  on  pain  in  the 
!rium,  which  was  followed  almost  always  by  a  thick  pulpy  motion,  in 
which  he  had  looked  for  blood,  but  never  saw  any.  In  the  long  vacation  In- 
vent to  an  hydropathic  establishment,  where  he  said  he  got  worse  and  \v.is 
halt'  starved.  Whether  in  consequence  of  that  or  the  disease,  he  was  very 
much  reduced,  perspiring  at  ni:,'ht  and  emaciating  rapidly,  and  so  weak  that 
I  \v.  nt  to  visit  him  at  his  lodirinirs  several  time-. 

He  had  never  sum-red  from  i-ouirh.  and  was  quite  sure  that  there  was  no 
hereditary  tendency  to  consumption  in  his  family. 


170  ABDOMINAL    PAIXS. 

When  I  first  saw  him  in  November  of  the  same  year  I  put  him  on  Haema- 
toxylum  for  five  days.     It  was  of  no  use.     I  then  prescribed — 
R. — Cupri  Sulphatis,  gr.  £; 

Pulv.  Ipecacuanhas  co.,  gr.  ij. 
In  pilula  ter  die. 

The  employment  of  this  for  six  days  removed  the  pain  in  the  stomach,  and 
reduced  the  motions  to  one  after  breakfast  and  one  at  night,  of  a  solid  con- 
sistence and  greenish  brown-color.  He  then  resumed  the  Haematoxylum, 
which  proved  sufficient  to  restore  his  appetite  and  strength. 

C —  continued  quite  well  and  went  into  the  army.  In  1863,  after  a  long 
review  day  at  Aldershot,  topped  up  by  drinking  a  quantity  of  Moselle  cup.  he 
got  an  attack  of  diarrhoea,  and,  fearful  of  a  relapse  of  his  old  complaint,  he 
came  up  to  see  me  in  London.  But  it  was  easily  stayed  with  a  little  Chalk 
Mixture  and  rest. 

He  called  at  my  house  in  1864,  when  I  was  ill  in  bed.  to  leave  a  card  and 
say  he  had  got  a  promotion,  so  that  there  is  no  reason  to  believe  he  has  con- 
tinued anything  bat  well. 

It  is  surprising  that  a  state  of  bowel  which  has  been  so  long 
coming  on  should  be  so  readily  and  quickly  cured.  Such  cases 
as  these  are  very  wholesome  to  the  mind,  strengthening  it  in 
faith  that  efficient  treatment  is  discoverable,  if  we  will  only  take 
the  trouble  to  look  for  it. 

Eemark  the  extreme  state  of  weakness  indicated  by  night 
sweats  and  emaciation.  A  mere  looseness  of  bowel  would  not 
induce  that,  but  only  a  looseness  which  secondarily  affects  the 
stomach. 

The  relaxation  of  the  bowels  is  not  always  so  immediate  in 
time.  Take  the  following  instance. 

CASE  CXXXYIII. — Miss  Louisa  P —  (age  uncertain),  in  September,  1857, 
complained  to  me  solely  of  general  languor  and  pain  at  the  epigastrium  of  an 
obscure  character,  and  I  put  her  on  Citrate  of  Iron  and  Prussic  Acid,  with 
milk  and  meat  diet,  and  directed  her  to  be  careful  not  to  press  upon  the  pit 
of  the  stomach  when  sitting  at  her  work  of  keeping  large  girls'  school.  "When 
I  saw  her  again  in  October  I  found  that  the  pain  at  the  epigastrium  came  on 
about  twenty  minutes  or  more  after  food,  that  it  went  downwards  to  the 
bowels,  and  was  followed  by  a  soft,  sometimes  liquid,  stool.  I  put  her  then 
on  Bismuth  and  Iron,  which  she  went  on  with  to  the  end  of  the  month  and 
got  well. 

Sulphate  of  Copper  would  probably  have  acted  quicker. 


ABDOMINAL    PAINS.  171 

SECTION    VI. 

Weight. 

This  is  a  feeling  like  that  often  locally  experienced  at  the 
:ming  of  sore-throat,  coryza,  influenza  on  the  chest,  leucor- 
rhcea,  gonorrhoea,  or  irritable  bladder.  In  those  diseases  it 
<rivr>  notice  that  the  internal  lining  membrane  of  the  spot  is  red, 
swollen,  soft,  and  beginning  to  be  coated  with  adhesive  mucus. 
In  the  more  advanced  stages,  as  soon  as  pus  is  formed,  the  sen- 
sation ceases. 

In  all  these  situations  it  is  sometimes  called  "oppression," 
sometimes  "  tightness,"  sometimes  "  distension ;"  but  I  think 
the  word  I  have  chosen  is  that  most  commonly  applied  to  the 
epigastrium.  It  is  so  in  my  notes  taken  from  word  of  mouth. 

Patients  will  sometimes  say  they  feel  as  if  they  had  eaten  too 
much,  but  their  account  of  their  meals  does  not  show  such  to 
be  the  fact.  And  in  those  whom  we  know  to  eat  too  much  we 
do  not  find  this  feeling  at  all  universal,  as  may  be  seen  by  refer- 
ence to  a  former  chapter  (page  97).  Besides,  if  the  feeling 
arose  from  over-fulness  of  the  stomach,  it  would  be  felt  most 
when  the  stomach  is  fullest,  namely,  during  a  meal ;  but  such 
is  not  their  experience. 

The  first  inclination  therefore  of  the  medical  pathologist  is  to 
refer  it,  when  complained  of  in  the  epigastrium,  to  the  develop- 
ment inside  the  stomach  of  the  catarrhal  condition  alluded  to 
above.  And  his  inclination  will  be  strengthened  by  the  perusal 
in  his  note-books  of  such  cases  as  the  following. 

<  \\XIX.-In  the  Post-mortem  Register  of  St  Mary's  Hospital 
tlnT«-  is  an  account  of  the  autopsy  of  Kliza  Ann  S — ,  who  died  November 
'J.")th.  1853,  aged  14,  of  dyspnrea  from  diseased  heart,  consequence  of  rheuma- 
tic fever,  and  towards  the  end  of  her  life  albnminuria  with  dropsy.  It  is  need- 
less to  detail  the  appearances  of  the  heart  and  lungs,  on  which  I  am  not  going 
to  comment,  except  to  eay  that  they  fully  accounted  for  the  illness  and  death. 
On  opening  the  stomach  its  inner  surface  was  found  covered  throughout  with 
a  coat  of  mucus  of  extraordinary  thickness  and  toughness.  \\<  tran.-parrney 
lined  by  tin-  admixture  with  it  of  a  good-deal  of  yellow-brown  matter. 
Tin-  microscope  showed  this  not  to  be  bread-crust  by  proving  the  ab.>en.  -••  ,.|' 
starch-irranulrs.  and  rendered  it  probable  that  it  was  digested  blood.  The 
microscope  exhibited  al-<»  the  |MFM6M6  Of  Mattered  spccinn-ns  of  surcina  vcn- 
tricula.  The  membrane  itself  was  stained  with  many  spots  of  punctate  con- 


172  ABDOMINAL    PAINS. 

gestion,  and  the  principal  contents  of  the  stomach  besides  mucus  was  coffee- 
ground  colored  fluid  of  neutral  reaction. 

She  had  been  under  me  in  the  wards  for  several  months,  and  on  referring 
back  to  the  record  of  the  case  during  life  for  symptoms  in  the  epigastrium,  I 
found  frequent  mention  made  of  "  weight,"  as  complained  of  in  that  situation, 
and  no  other  term  ever  used  to  describe  the  sensation.  I  find  also  that  she 
very  frequently  vomited  sour  matters,  and  had  a  sour  taste  in  her  mouth :  and 
that  the  vomiting  and  the  weight  embittered  the  poor  little  sufferer's  last  days. 
Her  appetite  was  good,  so  that  she  took  a  variety  of  food,  sometimes  in  re- 
stricted quantities,  sometimes  not ;  but  neither  dietary  nor  medicine  seemed 
to  alleviate  the  gastric  symptoms. 

The  vomit  during  life  had  several  times  been  examined  by  the  house-sur- 
geon for  sarcinse,  and  they  were  not  found ;  nor  was  it  frothy ;  nor  had  it 
ever  contained  the  coffee-ground  fluid  found  after  death,  but  was  intensely 
acid. 

The  natural  conclusion  is  that  the  weight  and  other  gastric 
symptoms  were  caused  by  the  continually  recurring  congestion 
and  pouring  out  of  mucus  in  the  parietes  of  the  stomach.  And 
the  symptoms  and  post-mortal  appearances  were  marked  enough 
to  make  one  view  this  as  a  typical  case. 

I  must,  however,  in  justice,  tell  that  in  twenty-three  cases 
collected  by  Dr.  Handfield  Jones,  in  which  an  excess  of  mucus 
was  found  after  death,  no  mention  is  made  of  weight  at  the 
epigastrium  among  the  symptoms  during  life.1  Possibly  it  was 
not  considered  of  sufficient  importance  to  make  a  note  of. 
Possibly  the  diseases  of  which  the  patients  died,  most  of  them 
acute  and  painful  diseases,  masked  even  to  the  sufferers  them- 
selves the  minor  evil. 

I  may  remark  in  passing  on  the  difficulty  almost  universally 
presented  by  this  last-named  factor  in  the  calculation,  when  an 
attempt  is  made  to  connect  the  post-mortal  appearances  with  the 
phenomena  recorded  during  life  in  all  diseases  which  are  not 
the  immediate  causes  of  death.  Like  other  things  pain  cannot 
be  in  two  places  at  once  (I  speak  of  course  metaphorically),  and 
when  you  are  having  a  tooth  out  you  fail  to  notice  the  operator 
treading  on  your  toe.  The  greater  ill  hides  the  lesser. 

Weight  is  most  c6mmonly  felt  towards  the  right  side  of  the 
epigastrium,  and  no  sensation  is  conveyed  up  the  oesophagus 

1  Handfield  Jones  "  On  the  Stomach,"  p.  74,  and  "  Medico-Chirurgical  Transac- 
tions," vol.  xxxvii.  p.  109. 


ABDOMINAL    PAIN'S.  173 

towards  tin-  :  it  is  in  the  pyloric  region,  according 

to  Dr.  Handheld  Jones,  tliat  tlie  catarrhal  state  of  mucous  mem- 
brane commonly  occurs,  and  I  am  disposed  to  attribute  to  the 
nerves  of  the  pylorus,  and  to  a  morbid  state  of  that  part  of  the 
8,  this  peculiar  gastric  sensation. 

In  CASE  CXXX1X  the  lesion  of  heart  was  adhesion  of  the 
inlium  with  enlargement.     In  the  next  instance  pure  val- 
vular lesion  without  enlargement  would  seem  to  have  been 
capable  of  producing  a  similar  state,  if  one  may  judge  from  the 

symptoms. 

[  L.—  Kllen  W — ,  aged  18,  a  domestic  servant,  was  in  St.  Mary's 
under  my  care  for  six  weeks,  from  February  13th,  1852,  and  again  was  ad- 
mitU'tl  in  January.  1853,  for  a  fortnight.  There  was  a  harsh  systolic  murmur, 
heard  loudest  at  tin-  level  of  the  aortic  valves,  the  sound  fading  away  gradu- 
ally towards  the  apex  of  the  heart.  The  pulse  was  always  from  105  to  120. 
and  she  complained  of  palpitation  when  asked  about  it.  She  was  very  pale 
and  weak,  unable  to  do  her  work,  bursting  into  a  perspiration  when  talked  to, 
and  having  a  violent  hysterical  fit  when  a  patient  in  the  ward  had  an  ai 
opened.  But  luy  chief  complaint  was  of  weight,  sometimes  amounting  to 
a<-tual  pain,  in  the  epigastrium,  and  of  vomiting. 

She  was  treated  at  first  with  small  doses  of  Hydrargyrum  cum  Cretd,  and 
saline  draughts.  She  got  worse  under  this  treatment,  and  the  pulse  remained 
quite  as  quick.  She  was  then  put  on  Decoction  of  Bark  with  Quinine,  and 
the  pulse  fell.  Mustard  plasters  to  the  epigastrium  seem  also  to  have  been 
of  use.  Then  the  weight  at  the  epigastrium  diminished,  and  the  vomiting 
ceased  :  but  coincident  with  that  the  patient  began  to  have  a  cough  ;  and  as 
the  expectoration  of  mucus  from  the  bronchi  increased,  so  the  gastric  symp- 
toms were  alleviated.  Then  she  regained  her  color,  got  stronger  and  heavier 
by  a  few  pounds.  The  pulse  went  down  to  84,  and  she  was  made  an  out- 
patient. 

11  owever,  she  was  admitted  again  at  the  beginning  of  next  year,  and  gave 
us  a  history  of  chronic  invalidism.  She  had  been  allowed  to  lie  in  bed  and 
indulge  her  feelings  of  languor.  There  was  no  cough,  but  she  said  that 
another  mucous  membrane,  the  vaginal,  was  affected,  and  she  frequently  had 
leucorrhcea.  She  complained  of  palpitation  of  the  heart,  but  not  of  the  gas- 
Mnptoms  so  much. 

Remark  here  how  the  effects  were  produced  now  on  one 

.  now  on  another,  not  on  both  at  once,  but  in  suc- 

:on.     The  supervention  of  the  bronchial  relieved  the  gastric 

eatarrh,  and  the  leueorrhceal,  brought  on  by  lying  in  bed  and 

coddling,  raooeedecL     Such  cases  can  seldom  be  cured  in  the 

short  time  which  hospital  neee.-.-itic.-  allow. 


174  ABDOMINAL    PAIXS. 

Mercurials  seem  very  bad  treatment,  but  just  at  that  epoch 
somebody  had  been  recommending  them  in  gastric  complaints, 
and  I  thought  that  such  a  one  as  this,  if  any,  ought  to  be 
benefited. 

A  minor  degree  or  weight  at  the  epigastrium  is  sometimes 
produced  where  the  heart  is  merely  excitable,  without  organic 
lesion. 

CASE  CXLL— G.  K.  R— ,  a  civil  engineer,  aged  33.  September  26th,  1861. 
He  suffers  a  good  deal  from  palpitation  of  the  heart,  which  is  brought  on  by 
even  the  slightest  mental  cause,  but  not  by  any  ordinary  bodily  exertion,  and 
there  is  a  feeling  as  if  the  heart  beat  irregularly  at  times.  The  stethoscope 
and  percussion  detect  no  abnormality  of  shape  and  sound  in  the  organ,  except 
the  quickness  of  beat  after  a  short  examination.  He  is  used  to  the  palpita- 
tion, and  what  he  would  complain  of  is  that  when  he  comes  out  in  the  cold 
after  breakfast,  to  go  to  his  work  in  London  from  Greenwich  by  the  steamer, 
he  experiences  an  oppressive  sensation  at  the  pit  of  the  stomach,  which  con- 
tinues at  least  the  greater  part  of  the  forenoon.  The  stomach  feels  as  if  a 
weight  lay  there,  or  as  if  it  were  tumid  with  wind,  which  on  examination  is 
found  not  to  be  the  fact. 

R —  was  directed  to  eat  milk-porridge  for  breakfast,  to  wear  thick  flannel 
over  the  epigastrium,  and  to  take  four  minims  of  Hydrocyanic  Acid  a  quarter 
of  an  hour  before  food. 

On  the  llth  of  October  he  comes  to  me  again,  saying  that  all  the  local  dis- 
tress has  passed  away,  and  that  he  feels  only  weakness,  for  which  he  is  ordered 
Quinine  and  Strychnine.  He  finds  milk-porridge  a  very  couvenient  breakfast. 

This  action  of  the  cold  air  is  just  what  one  feels  in  nasal  or 
bronchial  catarrh.  Flannel  is  a  very  good  preservative,  and 
acts  as  a  counter-irritant  as  well,  in  those  who  are  unaccustomed 
to  it. 

The  milk-porridge  was  intended  to  be  a  mass  of  even  moderate 
temperature,  in  fact  an  internal  poultice,  which  would  at  the 
same  time  be  sufficiently  nutritious  for  a  man  in  hard  work. 

Hydrocyanic  Acid  was  designed  to  act  on  the  whole  of  the 
pneumogastric  nerve,  inasmuch  as  it  was  through  its  chronic 
sensitiveness  in  the  heart  that  this  temporary  condition  of  the 
stomach  was  induced. 

Doubtless  in  CASE  CXLI  the  weather  had  considerable  influ- 
ence in  determining  the  condition.  In  the  next  it  seemed  the 
sole  factor. 


ABDOMINAL    PAINS.  175 

•  D — ,  aged  50,  but  old  for  her  age  (for  the  catamenia  had 
ceased  four  years),  requested  my  advice  in  November,  1K">(),  for  constipation, 
which  was  always  worst  in  wet  weather.  Butoninquiry  I  found  that  this  was  not 
all :  she  hiid  flatulence  and  an  oppressive  sense  of  weight  at  the  epigastrium, 
extending  to  the  right  bypochondrium,  after  meals,  and  it  was  this  which  was 
vati'il  hv  the  hygrometric  state  of  the  air.  She  lived  in  one  of  the  little 
old-fashioned  damp  Cinq  Ports,  and  a  removal  to  Ventnor'  for  the  winter 
made  all  the  difference  to  her. 

I  am  surprised  in  looking  over  my  notes  not  to  find  flatulence 
more  often  associated  with  weight  at  the  epigastrium.  The 
patirnts  so  frequently  speak  about  their  being  "blown  out" 
tliat  one  expects  it  in  every  case,  but  manual  examination  of  the 
abdomen  does  not  detect  it.  I  am  led  therefore  to  conclude 
that  this  feeling  "blown  out"  must  be  mainly  a  subjective  sen- 
u.  True  flatulence  is  usually  associated  with  more  purely 
neuralgic  conditions,  and  does  not,  like  the  subject  of  the  present 
section,  lead  to  the  diagnosis  of  catarrh.  Moreover,  the  sensation 
of  tumidity  is  by  no  means  a  marked  feature  in  real  tumidity. 
Patients  often  omit  to  notice  it. 

There  was,  however,  flatulence  in  Case  I*  along  with  weight, 
and  again  probably  in  the  following: — 

t'XLIII. — During  the  spring  and  summer  of  1857  I  had  several  visits 
from  a  thin,  withered  old  gentleman,  T.  S.  S — .  His  principal  complaint  was 
of  "  weight"  at  the  pit  of  the  stomach,  but  he  must  also  have  suffered  from 
flatulence,  as  I  see  that  I  have  prescribed  for  some  time  Charcoal  and  Strych- 
nine in  Powders,  which  I  should  not  have  done  except  for  that  symptom. 

Costiveness  is  a  very  usual  accompaniment,  and  in  the  follow- 
ing case  benefit  seemed  to  accrue  from  a  purgative  drug. 

I  I.I  V. — Thomas  K — ,  aged  45,  an  Irish  manufacturer,  asked  my 
advice  .July  1-lth.  K>7.  for  costive  bowels.  Confusing  cause  and  effect,  he 
attributed  to  that  costiveness  a  constant  "pressure"  on  the  epigastrium,  low 
spirits,  want  of  sleep,  and  anapliroilisia.  I  gave  him  a  prescription  for  five 
grains  of  Aloes  and  Myrrh  pill  with  onc-twellth  of  a  grain  of  Strychnine  every 
night,  and  de.-ired  him  to  take  them  for  a  week,  and  return  to  London  to  see 
me  airain  at  tliat  time.  To  his  surprise  they  had  not  acted  as  purgatives,  but 
Hieited  matured  >tnoU.  ||.-  was  very  much  better  in  every  respect,  and  con- 
tinued  to  take  small  <|iiautities  of  the  two  drugs  till  he  was  well. 

1  There   are  two  climates  at  Wntiior.  the  one  soft  and  suitable  for  sore  lungs, 
the  other,  which  is  ht-re  i>i?.-cribt)d,  dry  aud  bracing,  though  uot  cold. 

2  Page  31. 


176  ABDOMINAL    PAIXS. 

The  lowness  of  spirits  which  usually  accompanies  weight  at 
the  stomach  sometimes  amounts  to  thorough  hypochondriasis. 

CASE  CXLV.— Mr.  W— ,  aged  30,  was  brought  to  me  by  Dr.  Dunfield, 
January  19th,  1866,  on  account  of  the  persistency  of  a  sensation  of  weight 
towards  the  right  side  of  the  epigastrium,  coming  on  three-quarters  of  an  hour 
after  meals,  by  which  he  had  been  led  to  give  up  business  since  1864.  He 
was,  however,  none  the  better  for  giving  up  business.  His  nights  were  rest- 
less, and  he  was  often  woke  up  by  headache.  His  spirits  were  at  all  times 
low ;  he  had  no  actual  delusions,  but  he  took  the  gloomiest  view  possible  of 
everything,  and  was  inclined  to  be  miserly  in  the  management  of  his  income, 
which  was  ample  enough  for  his  wants.  The  tongue  was  covered  with  a  white 
fur  with  transverse  cracks.  The  gums  were  edged  with  a  pink  line,  but  were 
not  sore.  The  urine  contained  floating  crystals  of  oxalate  of  lime.  I  advised 
him  to  travel  abroad. 

I  suppose  it  must  be  from  depression  of  mind  being  so  often 
associated  with  discomfort  in  the  pyloric  region  of  the  stomach 
or  the  right  hypochondrium  that  we  derive  the  term  hypochon- 
driasis as  descriptive  of  that  mental  state — just  as  irritability  of 
temper  is  called  "  the  spleen"  because  it  so  often  accompanies  a 
stitch  in  the  splenic  region  of  females. 

The  white  furred  tongue  with  transverse  cracks  is  very  dis- 
tinctive of  an  irritable  condition  of  stomach,  but  it  does  not 
always  accompany  weight. 

The  pink  edges  to  the  gums  are  also  a  gastric  symptom. 
They  are  often  found  in  the  dyspepsia  of  early  phthisis ;  but 
they  are  pathognomonic  of  the  dyspepsia,  not  of  the  phthisis. 
As  in  this  instance  of  Mr.  W — ,  they  are  often  found  without 
any  tendency  to  pulmonary  disease. 

The  deposit  of  oxalate  of  lime,  instead  of  urates  or  uric  acid, 
in  the  renal  excretion,  is  common  in  such  dyspeptic  cases  as 
manifest  nervous  symptoms.  I  have  sometimes  found  with  it 
spermatozoa,  involuntary  seminal  emissions  being  also  frequent 
in  the  same  class  of  cases,  if  the  patients  lie  on  a  soft  bed  or 
with  the  head  low  or  on  their  backs. 

The  hypochondriasis  is  apt  to  take  a  form  engendered  by  the 
situation  of  the  discomfort.  The  patient  will  fancy  he  has 
something  strange  and  abnormal  in  the  stomach. 

CASE  CXLYI. — At  the  end  of  June,  1857,  I  saw  a  few  times  a  Mr.  B — ,  a 
middle-aged  man,  who  complained  of  weight  at  the  epigastrium  and  right 


ABDOMINAL    PAI  177 

hypochondrium.  IIo  and  I  <|uurn'lU'd  because  I  refused  to  treat  him  for  tape- 
worm in  tin-  stomach,  or  to  believe  that  In-  had  urn-  inside  him  anywhere.  The 
tongue  was  coated  with  white,  with  cracks  across  it ;  the  complexion  was  thick 
and  muddy.  The  patient  was  excessively  nervous  and  fearful,  and  complained 
;ally  of  a  "scratching  at  the  back." 

What  is  tliis  sensation  which  people  call  "scratching  at  the 
;  ?"     I  find  it  used  in  a  letter  to  me  from  a  girl  with  hys- 
terical paralysis  of  the  legs,  and  I  have  certainly  heard  it  from 
other  nervous  patients,  but  cannot  recall  the  circumstances,  nor 
-  it  convey  any  definite  meaning  to  my  mind. 

As  a  rule,  weight  and  heartburn  do  not  go  together.    Patients 
quite  understand  the  diiTerence,  and  when  skilled  by  unhappy 
rience  in  gastric  symptoms  treat  them  as  excluding  one 
another.     Thus — 

CX  I.  VI I.— Colonel  B— ,  aged  43,  consulted  me  July  30th.  1866,  about 
ain  loss  of  power  and  pain  in  the  legs.  Tracing  these  symptoms  to  the 

stomach,  I  inquired  about  the  habits  of  that  organ.  He  said  it  was  a  weak 
L  Did  he  suffer  from  he.irtlmrn  then?  No,  he  was  "  remarkably  free 

from  heartburn,"  he  said,  though  he  knew  what  it  was  very  well.     What  he 

felt  was  ••  a  weight  at  the  pit  of  the  stomach  and  in  the  liver,"  better  in  a 

bracing  climate,  worse  in  a  damp  relaxing  one. 

Y'-t  such  a  thing  does  happen  as  the  conjunction  of  weight 
ami  heartburn,  and  when  it  does  the  general  symptoms  are 
more  than  commonly  severe,  even  when  the  catarrh  is  not  bad 
enough  to  cause  vomiting. 

'  \LVIII.-J.  II.  R — ,  a  commercial  traveller,  aged  42,  was  sent  to 
me  by  his  family  doctor  who  had  watched  the  case.  September  '-'nth.  1858. 
He  had  always  l>eeii  a  fairly  temperate  man.  and  presented  a  healthy  weat he r- 
'.  but  with  a  look  of  distress  or  pain  in  his  face.  Naturally 
in  the  exercise  of  his  calling  lie  had  been  a  good  deal  exposed  to  changes  of 
temperature  and  to  wet.  and  to  irregularity  of  meals.  Gradually  he  1 
to  suffer  from  iudig<>tion.  which  ^n  \\  \\oi>e  and  wor>e.  He  had  an  almost 

iiit  weight  at  the  pit  of  the  stomach,  especially  towards  the  ri^l.: 
Hut  he  had  also  decided  heartburn  and  rising  of  fluid  in  the  mouth  of  uncer- 
tain character,  and  probably  consisting  of  regurgitated  food.  This  led  the 
-\iiiptoins.  to  vertigo  ami  occa.-i"ii;d  .-tumbling,  and  to  such 
confusion  of  thoughts  and  difficulty  in  fixing  the  attention  that  he  was  quite 
unfitted  for  business. 

He  was  cupped  to  a  small  amount  on   the  back,  was  bli.-tered.  and  had 
gr.  xv  of  Hismuth  tlnv.-  times  a  day.  and  a  small  .Vine's  and  Myrrh  pill  with 
one-twelfth  of  a  grain  of  .Strychnine  i\erv  ni-ht. 
12 


178  ABDOMINAL    PAINS. 

His  dietary  was  to  be  as  follows  : — 

For  breakfast. — Stale  bread  or  biscuit,  with  minimum  quantity  of  fresh 
butter,  milk  and  soda-water  in  equal  quantities  to  drink. 

For  dinner. — Lean  meat  once  cooked,  stale  bread,  one  spoonful  of  mashed 
potatoes  mixed  with  gravy,  weak  sherry  and  water  to  drink. 

Tea. — Same  as  breakfast. 

Supper. — A  biscuit  and  a  cup  of  beef-tea. 

In  ten  days  the  stomach  symptoms  quite  passed  away,  and  the  vertigo  was 
much  better. 

I  have  quoted  here  the  dietary,  as  a  specimen  of  what  is 
required  in  a  case  of  moderate  intensity.  It  was  arranged  to 
relieve  the  stomach  without  starving  it. 

Cupping  on  the  back  disperses  gastric  congestion,  and  is  more 
convenient  than  on  the  epigastrium.  At  the  same  time,  it  may 
aid  in  adjusting  the  disturbed  balance  of  circulation  in  the 
brain,  which  is  hinted  at  by  vertigo. 

To  recapitulate — I  think  the  sensation  of  weight  at  the  epi- 
gastrium is  one  of  the  most  important  evidences  of  a  catarrhal 
state  of  the  mucous  membrane  of  the  stomach.  It  may  exist 
at  all  times,  but  the  presence  of  food  intensifies  it  by  increasing 
the  amount  of  mucus  present. 

Its  spontaneous  relief  by  vomiting  when  intensified  by  food 
indicates  directly  one  of  the  most  important  parts  of  the  treat- 
ment, namely,  that  the  food  should  be  as  liquid,  light,  soft, 
and  as  quickly  soluble  as  is  consistent  with  a  full  amount  of 
nutrition. 

As  in  all  catarrhs,  Alcohol  is  injurious ;  -but  in  those  who 
habitually  take  it,  dilute  wine  and  water  must  be  conceded  in 
the  chronic  treatment. 

Local  treatment  of  congestion  by  abstraction  of  blood  and  by 
blistering  seems  useful.  It  may  be  used  when  the  amount  of 
digestion  still  carried  on  and  the  appetite  for  food  justify  its 
employment.  Even  a  considerable  amount  of  anaemia  need  not 
centra-indicate  it. 

The  most  efficient  pharmacopceial  agent  is  Quinine,  the  con- 
junction with  which  also  of  Strychnine  seems  likely  to  assist 
the  peristaltic  muscles  of  the  viscus  in  shaking  off  their  adher- 
ent coat  of  mucus. 

Where  there  is  an  obvious  increase  of  discomfort  very  soon 


A  I',  Iu>MI\  A  L    PAINS.  179 

food  IIydroey;i!iie  .Vi<l  is  useful,  not  only  as  a  palliative 
:   tor  allaying  the  sensitiveness  of  nerves  eontri- 
8  powerfully  to  the  disper.-ing  of  congestion. 

SECTION   VII. 
\\'-' fir  ing  pain. 

When  pain  is  constant,  it  assumes  what  is  called  a  "wearing'' 
character,  that  is  to  say,  its  moral  and  aesthetic  effect  is  out  of 
proportion  to  its  intensity;  though  slight,  it  consumes  away  all 
the  joy  of  life.  This  character  is  very  marked  in  the  case  of 
nit  even  pain  in  the  stomach.  The  patient  may  be  known 
at  once  by  the  pitiable  worn  look  of  despair  engraven  on  the 
countenance,  la  figure  yrippee  as  the  French  call  it,  which 

-•pie/  has  made  immortal  in  the  portraits  of  his  m; 
Philip,  the  artist's  truth  being  too  strong  for  the  courtier's  ilat- 

.     Considerable  emaciation  almost  always  accornpani 
The  reason  of  this  is  the  destruction  of  rest  by  night,  for  the 

' ration  of  rest  by  opiates  checks  the  emaciation. 
There  often  occur  shocks  or  stabs  of  sharp  agonj,  darting 
across  the  chest  or  the  walls  of  the  belly,  and  sometimes  they 
tla>h  even  into  the  arms  and  legs.     These  have  been  set  down 
•me  as  distinctive  of  cancer.   They  are  not  so ;  I  have  seen 
them  where  simple  ulcer  was  found  after  death,  and  I  have 
seen  cases  of  cancer  without  them. 

One  characteristic  feature  rarely  absent  is  its  keeping  the 
patients  awake  at  night. 

The  situation  of  it  points  out  the  locality  of  the  tissue  change. 

iM-ea-e  of  the  pylorus  is  felt  in  the  right  hypochondrium,  of  the 

rior  wall  of  the  stoma<-h  and  pani-reas  between  the  shoul- 

!so  disease  of  the  cardiac  is  usually  but  not  always 

felt. 

If  any  gastric  symptom  has  preceded  wearing  pain,  the  most 

il  is  weight. 

Wearing  pain  is  always  in  my  experience  increased  by  pres- 
sure, not  always  immediately,  but  after  an  interval. 

The    p:  is    l>ad:    it    is   pn-tty  sure  to  return,  for  it 

depends  on  some  organic  change  of  tissue  whieh  cannot  be 
•red  to  its   i  onditiou.     I  cannot  call  to  miml 


180  ABDOMINAL    PAINS. 

having  seen  an  example  of  pain  in  the  stomach  wearing  and 
constant,  so  as  to  interfere  with  the  nightly  rest,  in  which  I 
have  had  reason  from  the  future  progress  of  the  disease  to  infer 
a  normal  state  of  the  gastric  parietes. 

In  cases  of  ulcer  proved  by  the  fatal  event,  whenever  pain 
has  been  noticed,  it  has  been  of  this  character.  It  is  not  indeed 
perennial  during  all  the  years  that  the  ulcer  has  lasted,  but  it 
is  constant  during  the  time  when  the  degenerating  movement 
is  progressive,  when  the  ulceration  is  marching  onwards. 

In  nearly  all  cases  where  bloody  vomiting  otherwise  inex- 
plicable has  rendered  the  diagnosis  of  ulcer  the  most  probable 
one,  there  has  been  this  sort  of  pain,  occurring  for  considerable 
periods  together. 

Cancer  of  the  pylorus  causes  this  pain  in  the  right  hypo- 
chondrium,  even  before  ulceration,  quite  as  soon  as  any  tumor 
can  be  detected  by -manual  examination.  Cancer  of  other  parts 
of  the  stomach  usually  causes  pain  between  the  shoulders 
equally  early. 

I  shall  cite  a  series  of  cases  of  wearing  pain,  and  make  short 
comment's  on  them  .afterwards.  It  will  be  observed  that  I 
treated  and  prognosticated  all  as  if  there  was  structural  lesion 
of  some  sort,  though  of  the  nature  of  the  lesion  there  was  no 
absolute  evidence. 

CASE  CXLIX. — Hannah  W — ,  aged  34,  a  cook,  was  admitted  to  St.  Mary's 
April  21st,  1854.  She  had  a  worn,  unhappy  look,  and  rather  sallow  com- 
plexion. Her  body  was  stated  to  be  a  good  deal  emaciated  compared  with 
what  it  formerly  had  been.  She  had  enjoyed  good  health  up  to  about  two 
months  previous  to  her  entering  the  hospital,  at  which  period  she  was  taken 
with  a  severe  attack  of  vomiting — "a  bilious  attack."  Yomiting  had  returned 
'occasionally  since,  but  not  with  the  same  severity.  Her  principal  distress 
was  a  continued  wearing  pain  in  the  epigastrium,  which  rendered  her  miser- 
able throughout  the  day  and  broke  her  rest  by  night.  It  was  increased  by 
pressure,  and  to  a  certain  degree  by  meals,  unless  the  food  was  very  soft  and 
in  small  quantities  at  a  time.  She  attributed  it  to  the  heat  of  the  kitchen  she 
worked  in. 

Opiates  gave  temporary  relief,  and  helped  her  to  sleep  at  night.  So  that, 
after  a  good  dose  of  Morphia,  the  tongue,  usually  coated  with  a  white  fnr, 
was  noticed  to  become  clean. 

Six  Leeches  were  applied  to  the  epigastrium,  six  grains  of  Bismuth  given 
three  times  a  day,  and  the  diet  restricted  for  a  week  to  broth  without  meat  in 
it,  and  to  cold  milk  and  water. 


ABDOMINAL    PAINS.  181 

It  appeared  that  previous  to  admission  the  patient  had  been  freely  treated 
by  means  of  purgatives,  her  bowels  being  very  costive.  They  were  entirely 
left  off,  and  in  consequence  the  bowels  opened  themselves  only  once  in  five 
days.  This  rest  seemed  of  great  use. 

On  the  'JTth  .-he  ftmud  herself  able  to  eat  a  bit  of  beef  given  her,  and  the 
next  day  some  bread,  so  she  was  allowed  to  have  it. 

On  May  2d  she  had  lost  her  epigastric  pain,  and  on  the  6th  was  able  to 
return  home.  On  the  20th  she  came  to  show  herself  to  me,  and  to  report 
that  a.-  yet  she  had  no  return  of  the  pain. 

<  I .      Hannah  P — ,  aged  48,  was  admitted  to  St.  Mary's  August  17th, 
She  was  the  wife  of  a  laboring  man  unable  to  work  by  reason  of  paraly- 
:.d  she  had  for  some  time  supported  him  by  going  out  to  field  labor;  so 
iie  liveil  very  hard,  and,  moreover,  had  lost  thirteen  teeth,  so  that  even 
•  Mtrh  food  she  did  get  was  improperly  chewed.    Up  to  the  previous  Feb- 
ruary, however,  she  had  been  in  strong  health.     Then  she  began  to  suffer  pain 
in  the  epigastrium  at  odd  times  ;  but  it  did  not  prevent  her  earning  her  wages 
till  the  summer,  when  it  became  constant,  and  she  was  entirely  invalided, 
partly  from  the  pain  and  partly  from  giddiness  and  a  feeling  of  prostration. 

On  admission  her  countenance  was  worn  and  sallow,  her  appetite  was  good, 
the  pulse  small  and  weak,  the  tongue  cleaner  and  redder  than  natural,  the 
bowels  costive.  The  pain  at  the  epigastrium  was  constant,  and  increased  by 

she  complained  of  want  of  sleep. 

At  first  she  was  treated  with  Hydrocyanic  Acid,  but  no  benefit  at  all 
resulted.  Then  a  blister  to  the  epigastrium,  on  which  great  relief  immedi- 
ately be^an.  Then  she  had  a  grain  of  Opium  every  night  and  the  following 
draught : — 

R. — Misturse  Ferri  co.  fl.^j. 

Acidi  Galilei,  gr.  iv  ter  die. 

was  able  to  take  a  pint  and  a  half  of  milk  with  Lime-water  in  the  day, 
ami  egg  and  other  diet  as  well.  Hut  she  did  not  lose  her  pain  in  the  stomach 
till  I  cut  her  down  to  the  milk  and  Lime-water  only,  and  gave  her  a  drachm 
of  I!i~muth  three,  times  a  day.  The  latter  prescription  and  the  keeping  of 
the  blistered  surface  open  for  a  month  was  at  last  successful,  so  that  on  Sep- 
tember 19th  she  was  able  to  begin  eating  half  a  mutton-chop  daily,  and  on 
-th  was  discharged. 

I.     Mary  Ann  S — ,  aged  TJ.  admitted  to  St.  Mary's  January  'J.'M. 
attributed  her  illness  to  debility  induced  by  her  last  confinement.     She 
M  subject  to  pains  in  the  epigastrium,  which  came  on  about  once  a  fort- 
night and  /*  during  the  period  of  the  attack. 
One  of  these  attacks  had  commenced  on  the  ISth,  when  the  pain  was  :_'• 
across  the  pit  of  the  ,-tom.icli.     On  tin-  I'.Hh  it  passed  over  to  the  right  side, 
where  it  became  fixed  and  constant.     She  attributed  this  attack  to  a  meal  at 
which  she  ate  both  rice  and  potatoes.     It  had  much  diminished  on  her  ad- 

n  to  the  ward. 

On  examination  of  the  abdomen  there  was  found  a  circumscribed  spot  to 
the  outside  of  the  right  red  us  alulm:.  le,  and  within  two  inches  of  the 


182  ABDOMINAL    PAINS. 

costal  cartilages,  which  was  excessively  tender  on  pressure.  This  spot 
appeared  also  somewhat  tumid  and  tense  ;  the  patient  said  it  had  been  more 
tumid  two  days  before,  and  had  been  reduced  by  the  application  of  a  sinapism. 
There  was  resonance  on  percussion  between  this  spot  and  the  liver,  the  extent 
of  whose  dulness  was  quite  normal. 

Six  Leeches  were  put  on  the  epigastrium,  followed  by  the  continuous  appli- 
cation of  a  bran  poultice.  She  had  gr.  xv  of  Bismuth  three  times  a  day,  and 
a  diet  of  milk  and  Lime-water,  with  a  pint  of  beef-tea  daily.  She  entirely 
lost  her  pain,  but  eating  a  bit  of  meat  at  supper  on  the  31st  brought  back  a 
short  relapse,  which  was  immediately  checked  by  the  fresh  application  of  half 
a  dozen  Leeches.  She  was  made  an  out-patient  on  February  2d. 

CASE  CLII. — Sarah  B — ,  aged  40,  was  admitted  to  St.  Mary's  March  11, 
1864.  She  had  suffered  seven  years  from  frequent  attacks  of  continuant  /"?/'// 
in  the  epigastrium,  sometimes  accompanied  by  vomiting ;  and  sometimes  the 
vomiting  had  contained  blood,  though  it  did  not  do  so  when  in  the  hospital.  She 
had  found  by  experience  that  hot  food  was  apt  to  bring  on  these  attack?,  and 
that  the  danger  was  closely  proportioned  to  the  degree  of  temperature.  She 
had  consequently  acquired  the  habit  of  taking  everything  cold  and  iced  if  she 
could  get  it.  (The  notes  of  this  case  are  imperfect.) 

CASE  CLIII. — William  G — ,  aged  33,  country  gentleman,  February  1st, 
1866.  He  has  suffered  for  eight  months  from  almost  constant  pains  in  the 
right  side  of  the  epigastrium,  which  is  increased  by  pressure  and  by  external 
cold.  His  countenance  has  got  sallow,  and  he  has  lost  more  than  fourteen 
pounds  in  weight.  He  has  no  cough,  and  the  chest  seems  healthy.  On 
manual  examination  of  the  painful  spot  it  is  resonant  on  percussion.  The 
bowels  are  costive.  They  were  regular  before  he  took  a  quantity  of  Mercury 
and  purgatives.  The  pain  was  increased  by  riding  but  not  by  food.  His  rest 
was  broken  by  it.  He  did  not  vomit. 

I  put  him  on  two  grains  of  Quinine  dissolved  in  lemon-juice,  with  three 
minims  of  Hydrocyanic  Acid  twice  a  day  and  sent  him  to  Bath  till  March  5th. 
By  that  time  the  constancy  of  the  pain  was  much  abated,  and  he  w-.is 
enabled  to  ride  without  increasing  it.  He  had  gained  two  pounds  in  weight. 
He  continued  to  improve  till  the  middle  of  May,  when  he  returned  to  his 
home  in  Lincolnshire,  a  low  aguish  district,  and  almost  immediately  relapsed 
and  returned  to  me  in  London.  He  said  he  had  found  several  times  before 
that  a  visit  to  Lincolnshire  made  him  worse,  but  he  thought  the  summer 
weather  would  make  it  safe.  "  To  keep  him  out  of  harm's  way"  I  have  re- 
commended him  to  travel  for  a  year  or  two,  as  it  is  to  be  feared  these  relapses 
may  constantly  occur  on  exposure. 

.  CASE  CL1V. — James  N — ,  an  upright  military-looking  country  gentleman 
of  50,  was  always  hearty  and  strong  till  he  had  the  smallpox  in  18G4,  after 
which  he  became  costive  in  the  bowels,  and  got  into  the  habit  of  taking  so 
much  purgative  medicine  that  without  it  no  action  could  be  secured.  In  the 
summer  of  1866  he  began  to  suffer  from  discomfort  at  the  epigastrium,  which 
grew  gradually  more  frequent,  so  that  when  I  saw  him  in  October  it  was 
always  produced  by  food,  and  often  also  arose  at  other  times,  especially  when 


ABDOMINAL    PAIN'S.  183 

in  bed.  T  gave  him  a  tonic  of  Quinine  and  Strychnine  with  some  pills  of 
Alni'-s  and  Myrrh  with  Strychnine.  This  at  first  seemed  to  afford  a  little  tem- 
porary relief.  and  the  patient  was  anxious  to  make  the  best  of  matters.  Hut 
med  to  get  weaker  and  thinner,  and  then  the  pain  became  constant,  and 
was  observed  to  be  increased  by  riding  on  horseback  or  in  a  rough  carriage. 
Ami  I  thought  after  a  fair  trial  that  the  bitter  drugs  made  the  pain  worse,  so 
I  left  them  off  and  ordered  only  some  Cod-liver  oil.  Also  one  spot  in  the 
of  the  epigastrium  I  found  tender  on  pressure,  and  at  the  same  point 
1  could  feel  the  pulsation  of  the  aorta  with  abnormal  clearness,  not  stronger 
perhaps  than  natural,  but  more  readily  felt  by  the  finger.  On  these  grounds 
I  held  it  my  duty  to  give  a  bad  prognosis. 

After  this  1  heard  no  more  of  the  case  for  nearly  three  months,  when  Mr. 

Faithorne,  under  whose  care  he  then  was,  wrote  to  me  to  say  that  Mr.  X — 

had  persevered  in  taking  medicines  for  some  time,  when  ho  found  himself  no 

1  ictter  and  left  off.     He  was  growing  gradually  weaker,  and  derived  relief  to 

i  ic  pains  only  from  Morphia.     There  was  no  tumour  in  the  epi- 

iim. 

CLV.—  Miss  B — ,  a  thin,  active  person  of  slight  muscular  develop- 
ment, who  looks  about  five-and-thirty,  has  been  in  the  habit  of  walking  to 
church  every  morning  at  eight  o'clock  without  taking  any  food;  then  swallow- 
ing her  breakfast  and  passing  the  greater  part  of  her  day  in  "parishing," 
laden  with  a  great  pocket  full  of  books,  rice,  tea,  sugar,  loaves,  &c.,  fastened 
round  her  waist.     For  some  mouths  past  she  has  experienced  a  pain  in  the 
pit  of  the  stomach  ten  minutes  or  a  quarter  of  an  hour  after  she  begins  to 
eat,  and  lately  this  has  become,  cnn^nnt.     She  has  also  occasionally  vomited 
meals,  and  has  noticed  mucus  and  blood  in  what  has  been  thrown  up. 
- ymptom  has  no  connection  with  the  monthly  period.     Lately  she  has 
i. -posed  to  be  hysterical,  but  being  of  a  strong-minded,  cheerful  tem- 
perainent  of  mind,  has  not  given  way  to  it.    Catamenia  and  al vine  excretions 
natural.     Feet  apt  to  be  cold. 

On  examination  of  the  bare  abdomen,  there  is  pain  developed  not  by  gently 
touching,  but  by  firmly  prcssini:  with  the  finger-tips,  the  middle  of  the  epi- 
:um.  just  below  the  ensiform  cartilage. 

1 .".'/'(.  l-''.i'i.     To  leave  off  entirely  tea  and  all  viands  containing  su-rar. 

To  lie  in  bed  till  half-past  eight,  and  never  go  out  till  she  has  had  a  good 

meal.     To  leave  off  stays,  and  the  weights  sn-p^nded  round  the  waist,  and 

when  she  is  stronir  enough  to  carry  burdens,  to  carry  them  in  a  basket.     To 

\  nuina  draught  twice  a  day.  and  to  lie  provided  with  a  bottle  of  ainmo- 

•1  tincture  of  Valerian,  of  which  'ake  two  teaspoonfuls  in  water 

whenever  she  feeds  inclined  to  have  a  cry. 

.I'liiinirij  'JT'/i.  1-''.T.— A  strict  conformity  to  rule-  has  I. ecu   rewarded  with 
i.-ralile  improvement .  and  she  ha-  hail  no  occasion  to  take  the  Valerian. 

.in  on  pressure  of  the  eiiiuM-trium. 

'I'o  wear  a  pii-ee  of  Kniplastruin   I'  i:tn-  on  the  e 

trium,  and  to  take  four  grains  of  I  \>  lina  and  Iron  in  the  st- 

a  her  med. 


184  ABDOMINAL    PAIXS. 

February  28th. — A  return  to  her  old  home,  and,  I  fear,  its  associated  dnties, 
has  caused  a  relapse  into  her  former  state.  She  appears  also  nervously  ex- 
cited, to  judge  by  her  letter  received  to-day. 

R. — Tincturae  Valerianae  Amm.  fl^ij  ter  die. 

Advised  to  travel,  if  she  has  a  chance,  in  the  South  of  France  and  Italy  for 
the  spring,  but  to  avoid  Rome,  Pisa,  and  the  like. 

April  24:th. — Has  remained  at  home,  steadily  persevering  in  the  tonic.  Has 
gained  much  flesh,  but  not  entirely  lost  her  pain. 

CASE  CLVI. — A  lady's  maid,  Sarah  S — ,  aged  33,  was  admitted  to  St. 
Mary's  September  10th,  1852,  for  constant  wearing  pain  at  the  epigastrium, 
made  sharp  by  pressure  or  by  eating,  vomiting  and  emaciation.  She  had  also 
suffered  from  waterbrash  of  clear  fluid,  and  acidity.  She  said  that  in  every 
spring  for  the  three  years  previous  she  had  had  an  attack  of  bloody  vomiting. 
She  attributed  it  to  her  having  worn  a  long  busk  to  her  stays,  which  conse- 
quently she  had  left  off. 

CASE  CLVII. — James  M — ,  aged  32,  a  potman,  was  attacked  at  the  begin- 
ning of  April,  1860,  with  pain  of  a  continuous  character  in  the  pit  of  the 
stomach.  This  continued  getting  worse  till  the  16th,  when  in  the  act  of 
vomiting,  to  which  he  had  become  subject,  he  brought  up  about  half  a  pint 
of  blood  black  in  color.  In  the  afternoon  of  the  next  day  he  brought  up  as 
much  as  three  pints  of  thick  black  blood  in  masses  so  tough  as  nearly  to 
choke  him.  The  tongue,  however,  remained  clean  and  moist,  and  the  pulse 
was  only  74 ;  the  heart  and  lungs  were  healthy,  and  he  had  lost  the  pain  in 
the  epigastrium  even  when  it  was  pressed.  All  which  things  considered,  it 
was  not  thought  right  to  detain  him  above  four  days  in  hospital,  especially 
as  he  wanted  no  medicine. 

CASE  CLYIII. — Sarah  G — ,  aged  33,  housemaid,  always  enjoyed  good 
health  to  the  middle  of  June,  1857,  when  she  was  laid  up  with  sore  throat 
at  first.  This  passed  into  a  wearing  pain  at  the  epigastrium  aggravated  by 
food,  and  accompanied  by  several  attacks  of  vomiting,  during  which  she  threw 
np  blood.  She  became  an  out-patient  at  St.  Mary's  under  Dr.  Markham's 
care ;  and  he,  finding  her  weakness  and  paleness  increase  with  alarming  rapi- 
dity, and  seeing  the  tongue  dry  and  furred  as  in  hemorrhagic  fever,  recom- 
mended her  being  admitted  on  August  22d.  We  then  found  as  Dr.  Markham 
had  suspected,  but  the  patient  constantly  denied,  that  she  passed  blood  by 
the  bowels  whenever  they  were  opened.  This  required  to  be  done  by  artifi- 
cial means,  for  she  was  very  costive.  On  one  occasion  the  feces  contained  a 
clot  of  fibrin,  washed  colorless,  as  big  as  an  egg.  After  observing  and  exa- 
mining her  for  a  few  days,  I  gave  her 

R. — Plumbi  Acetatis  gr.  ij, 

Opii  gr.  ^.     In  pilula  ter  die. 

She  took  this  for  three  days,  and  then  her  bowels  were  open  of  their  own 
accord,  and  she  passed  a  dark  feculent  solid  stool  containing  no  blood.  The 
pills  were  therefore  left  off,  and  she  was  treated  with  occasional  doses  of 
Castor  Oil  to  clear  the  bowels  of  the  remedy. 


ABUOMIXAL    PAINS.  185 

But.  for  some  reason  or  another,  perhaps  a  relapse  of  the  hemorrhai:'-.  I 
began  tin- Acetate  of  Lead  again  on  September  1  lit h,  giving  it  her  only  at 
night,  however.  On  the  21st  she  passed  a  quantity  of  flocculent  fibrin  with- 
out blood.  On  the  23d,  a  blue  border  was  observed  along  the  gums,  so  the 
was  again  left  ofT,  and  she  does  not  seem  to  have  lost  any  more  blood 
during  her  residence  in  the  hospital,  viz.  till  October  16th. 

X.  -Klixa  F— ,  aged  35,  was  admitted  August  21,  1860,  having 
for  a  fortnight  suffered  from  vomiting  of  her  food,  tasting  and  smelling  sour. 
That  morning  she  had  begun  to  consider  her  case  serious,  from  having  thrown 
up  in  addition  some  clotted  blood  to  the  extent  of  a  few  ounces.  There  was 
pain  in  the  epigastrium,  niiinimj  thrim<jh  to  the  back  and  increased  by  very 

She  was  ordered  a  Blue  pill  and  Castor  oil,  and  then  twenty  minims  each 
of  Sulphuric  Acid  and  Oil  of  Turpentine  in  a  mixture  three  times  a  day: 
idso  i.-e.  milk,  and  cold  beef-tea,  like  all  other  patients  with  haematcn 
but  the  next  day  the  treatment  was  discontinued,  as  the  vomiting  had  c 

Tin-re  was  no  more  blood  thrown  up  till  the  2:!d  ;  the  medicines  were  re- 
sumed, and  it  ceased.  I'.ut  all  along  she  was  passing  black  stools  apparently 

-'illLT  of   dLre>ted   blood. 

Then  her  bowels  became  costive,  and  she  took  only  some  Decoction  of 
Cinchona,  and  was  discharged  on  September  7th. 

Tn  CASE  CXLIX  it  may  be  remarked  that  the  disease  is 
attributed  to  the  high  temperature  to  which  her  occupation 
exposed  the  patient.  I  question  whether  this  accusation  I 

•  >ne:  but  probably  the  heat  caused  pain  to  the  injured  part, 
an<l  was  on  this  ground  set  down  as  the  origin  of  the  injury. 
F.  -r  it  may  be  generally  observed  that  hot  food,  as  in  CASE  CLII, 
gives  rise  to  distress  in  tissue  lesions  of  the  stomach. 

CASE  CL  is  an  instance  of  what  must  strike  every  practi- 
•r  in  a  mixed  population,  that  too  low  living  and  the  low 
vitality  which  is  its  consequence  is  a  more  frequent  agent  in 
the  production  of  disorganizing  lesions  than  too  full  living. 
Almost  all  patients  in  whom  we  can  diagnose  chronic  gastritis 
arc  poor  people. 

Remark  in  these  two  cases  the  use  of  Opium.     It  produced 

no  constipation,  or   it  would   have  been  left  otV:   indeed   in  the 

first  it  s'-rni'-d  to  take  the  place  of  purgatives,  with  which   the 

:it  had  been  previously  tre.-u.-d.     This  tolerance  of  Opium 

without  arrest  of  ;  fanotioc  ilia  L  have  found 

the  rule  wherever  the  dm-    is  re.-illy  iV'pii^ite.      When  it 

routines  the   bowels,  it  generally  is  superfluous  and   meddling 


186  ABDOMINAL    PAINS. 

In  these  two  cases  I  suspected  chronic  gastritis  without 
ulceration. 

In  CASE  CLI  the  tumefaction  of  the  localized  spot  led  me 
to  suspect  old  adhesions  of  the  peritoneum  giving  rise  to  the 
immediate  symptoms  of  congestion.  The  relapse  on  the  attempt 
to  eat  solid  food  is  interesting,  as  is  also  the  rapid  relief  by 
Leeches. 

In  CASE  CLIII  local  depletion  would  probably  have  been 
desirable.  The  slowness  of  relief  without  it  presents  a  contrast 
to  the  other  cases.  But  I  was  loath  to  employ  it  on  account  of 
the  malarious  taint  with  which  the  patient's  constitution  was 
blighted.  Aguish  people  bear  loss  of  blood  very  ill. 

In  both  CLIII  and  CLIV  it  is  to  be  remarked  that  the 
motion  of  riding  was  especially  noxious,  though  both  were 
sporting  men  and  more  at  home  a-horseback  than  on  their  own 
legs.  This  pain  from  motion  is  a  clear  sign  of  structural  lesion. 
The  localized  pulsation  of  the  aorta  is  another  pathognomonic 
phenomenon.  The  gradual  increase  of  the  symptoms  is  an  in- 
teresting feature  in  the  case. 

CASE  CLV,  though  not  poor,  yet  still  took  less  food  than  is 
required  by  a  spare  body  exercise  as  hers  was.  The  weight  of 
the  bulky  pocket  pressing  on  the  waist  was  assigned  by  her 
friends  as  the  immediate  external  cause  of  her  ailment,  and  I 
cannot  but  think  they  were  right. 

The  renewal  of  life  induced  by  a  trip  to  a  Mediterranean 
climate,  as  recommended  to  Miss  B — ,  for  the  spring,  is  very 
striking  to  those  who  have  tried  it,  especially  in  cases  of  chronic 
tissue-change.  I  made  the  excuse  in  CASE  CLIII  that  it  was  to 
keep  the  patient  out  of  harm's  way,  and  so  it  was  partly,  but  I 
believe  it  does  more  than  that,  and  has  really  a  regenerative 
power  over  the  degenerated  substance  of  the  body.  Statistical 
and  self- experimental  reasons  are  given  for  this  in  a  little  mon 
ograph  "  On  the  Climate  of  Italy,"  founded  on  my  own  case. 

Borne,  however,  and  Pisa,  and  perhaps  a  feAV  other  places  of 
less  note  and  less  tempting,  must  be  shunned  by  all  persons  of 
an  hysterical  temperament.  This  caution,  though  in  a  less 
degree,  applies  equally  to  young  men  as  to  young  women,  as  I  • 
am  informed  by  an  intelligent  clerical  student  at  the  Collegio 
Pio,  who  has  of  his  own  accord  made  this  remark  to  me,  as  to 


ABDOMINAL    PAINS.  187 

(Tect  of  the  climate  on  young  Englishmen  who  go  there  to 
study  for  holy  or 

CASES  CLV   and   CLYI  may  both  recall  the   4th  and  5th 
sections  in  the  last  chapter  in  which  somewhat  similar  pains  and 
ctYe.-ts  are  attributed  to  the  trade  of  shoemaker  and  to  tight- 
lacing.     Constant  pressure  upon  the   outside   of  the  stomach 
have  a  disorganizing  power  like  that  of  pressure  of  a 
jn  body,  tumor  or  the  like,  inside.     The  stomach  is  worn 
just  as  the  ribs  are,  by  the  gentle  but  continuous  pressure 
of  an  a  -urism. 

In  CLY,  CLVI,  CLVII,  CLVIII,  CLIX,  the  diagnosis  of 
>;i   was   rendered   probable  by  the  hemorrhage  being 
joined  to  the  continuity  of  wearing  pain. 

In  CLIX  the  running  of  the  pain  through  to  the  back  is 
noticed. 

SECTION    VIII. 
Soreness  on  pressure. 

Soreness  on  pressure  is  so  generally  in  all  naturally  inscnsi- 
xirts  an  indication  of  structural  change  that  we  all  of  us 
matter  of  course  apply  this  diagnostic  sign  to  the  organs 
of  digestion.    Where  it  is  constant  in  any  one  part,  independent 
of  the  presence  of  food,  and  proportioned  in  its  degree  to  the 
amount  of  pressure,  it  appears  to  me  pathognomonic,  and  can 
hardly  arise  from  any  other  cause.     It  is  sometimes  immediate, 
and  sometimes  does  not  come  on  till  the  lapse  of  a  certain  in- 
1.     In  the  former  case  there  is  a  little  vagueness  in  the 
.  for  some  people  are  so  much  more  sensitive  than  others, 
and  0  'to  having  the  epigastrium   i  that  they  cry 

out  without  sufficient  OC  -  requisite  not  to  be 

ved   by   the   hy;  -ia.     The  pain   which   comes  on 

alter  an  interval,  on  the  other  hand,  is  a  very  determinate  svmp- 
tom.  and  is  never  simulated  or  imaginary.  It  gives  very  ac- 
curate information  that  an  organic  change  of  some  kind  has 
taken  place  in  t'  'ire  of  the  stomach. 

Whenever,   then,   tenderness  on   pressure  constant  1\ 
whether  accompanied  or  not    by  constant   or  wearing  pain,  and 
whatever    the    other   symptoms    may    be.    whether    heartburn, 
:!,  I   think  we  are  justified   in  employing 


188  ABDOMINAL    PAIXS. 

local  alternative  means,  mustard  poultices,  blisters,  leeches,  or 
cupping.  Water  compresses  are  not  so  efficient ;  I  think  those 
who  fancy  they  have  found  them  useful  must  have  fallen  in 
with  other  forms  of  gastric  pain  and  mistaken  them  for  tender- 
ness. 

An  all-important  part  of  the  treatment  is  complete  rest. 

The  action  of  this  may  be  seen  by  the  rapidity  with  which 
the  patients  get  well  in  the  hospital. 

Tenderness  on  pressure  does  not  centra-indicate  an  analeptic 
restorative  treatment  being  conjoined  with  the  local.  Indeed, 
it  demands  it.  Numerous  instances  of  this  may  be  seen  in  cases 
already  cited,  perhaps  the  most  striking  from  the  symptoms 
being  capable  of  being  depicted  in.  number  and  weight,  is  CASE 
CVIII,  of  a  young  Irish  woman,  who  gained  twenty-one  pounds 
of  flesh  in  twelve  days,  in  spite  of  being  leeched  every  other 
night  during  nearly  all  the  time  for  waterbrash,  with  intermit- 
tent pain  at  the  epigastrium  and  tenderness.1 

Pain  felt  only  on  pressure  in  a  part  does  not  require  any 
palliatives  except  not  to  press.  This  is  a  platitude  perhaps ; 
but  still  both  doctors  and  patients  are  the  better  for  having  the 
fact  brought  to  mind,  since  these  out  of  anxiety  find  it  difficult 
to  keep  their  fingers  away,  hoping  each  minute  to  find  the  pain 
gone,  and  those  are  tempted  by  a  love  of  accuracy,  hard  to 
blame,  into  a  needless  frequency  of  examination. 

SECTION   IX. 
Anomalous  pains. 

CASE  CLX. — Mrs.  S — ,  aged  40,  used  to  visit  my  house  frequently  in  1849 
with  a  daughter,  whom  I  was  attending  for  cutaneous  disease.  One  day, 
though  at  the  time  in  perfect  health,  she  desired  my  advice  about  a  curious 
pain  in  the  pit  of  the  stomach,  which  from  time  to  time  assailed  her.  It  came 
on  gradually,  was  not  severe  enough  to  lay  her  up,  but  constant  and  worry- 
ing while  it  lasted,  namely,  for  about  a  week  or  ten  days  at  the  most.  The 
first  thing  I  made  out  about  it  was  that  it  usually  succeeded  to  any  mental 
worry  or  unusual  bodily  exertion  for  several  days.  On  further  inquiry  I  found 
it  invariably  coincident  with  the  catamenial  periods,  which,  however,  were 
regular,  not  excessive,  and  accompanied  by  even  less  pain  in  the  loins,  uterus, 
or  groins,  than  most  women  accuse.  It  appeared  in  fact  to  be  a  dysinenor- 
rhceic  pain,  misplaced  at  the  wrong  end  of  the  abdomen. 

1  See  page  149. 


ABDOMINAL    PAIXS.  189 

I  gave  her  a  course  of  Quinine  and  Iron  for  the  nonce,  and  desired  her  to 
take  a  special  d.-e  .if  Hydrocyanic  Acid  and  Opium  if  the  pain  came  on  again. 
This  seems   to  ha\c  I-.  >  n  suo  c->ful,  for  though  she  brought  her  daughter 
il  times  during  the  next  year  she  said  no  more  about  herself. 

Though  she  appeared  in  perfect  health,  the  mere  fact  of  being 
an  anomalous  pain  showed  weakness,  and  constituted  the  periodi- 
cal discomfort  which  is  the  normal  portion  of  the  sex,  or  dys- 
menorrhoea. 

The  above  is  a  specimen  of  the  most  usual  degree  in  which 
uterine  pains  are  felt  in  the  stomach,  but  sometimes  they  are 
more  serious,  as  in  the  following  instance: — 

\  I  -Jane  R — ,  aged  25,  a  housemaid,  was  admitted  under  me  at 
the  hospital  l-Yliriiary  16th,  1852.  She  was  a  personable  robust  country- 
M.-inan,  who  had  lately  come  up  to  service  in  London.  Her  tongue  was  clean, 
her  pulse  H4.  full  and  strong,  her  skin  normal,  her  urinary  and  fecal  excretions 
reported  natural.  Her  mistress  said  that  for  three  days  Jane  had  complained 
of  pain  in  the  lower  part  of  the  chest  in  front.  That  it  was  increased  by  food, 
•  •nseiiueiitly  she  had  "eaten  nothing,"  that  is  to  say,  had  taken  only 
liquid  food.  She  got  an  out-patient's  letter  to  the  hospital,  but  on  her  way 
to  use  it  was  taken  so  much  worse  that  she  was  obliged  to  be  admitted. 

She  sat  up  in  bed  rubbing  her  epigastrium  with  her  hand,  and  expressed 
hers. -If  as  in  great  pain.  Rubbing,  however,  gave  her  no  relief,  nor  did  pres- 
sure ;  but  it  could  be  borne  without  any  increase  of  pain. 

The  catamcnia  had  been  absent  two  months.  A  large  Linseed  poultice 
was  applied  to  the  abdomen,  she  took  a  four-grain  Calomel  powder  imme- 
diately, and  a  Senna  draught  three  hours  afterwards.  The  same  day  the  eata- 
nicnia  occurred,  not  copious  (they  were  never  so,  she  said),  but  sufficient. 
tln>  pain  instantly  ceased,  and  she  was  well  enough  to  be  discharged  on  the 
18th. 

The  disgorgal  of  the  portal  veins,  by  a  mercurial  and  a  pur- 
gat  ive,  is  a  capital  way  of  l>ringing  on  thecatamenia  in  a  robust, 
fiill-bluodetl  prison.     Kemember,  however,  that  I  do  not  recom 
\  it  in  those  more  common  eases  where  the  amenorrhooa  is 
v  an  evidence  of  the  absence  of  menstrual  blood  to  be  dis- 
eharged. 

It  has  seemed  to  me  that  pains  in  the  loins,  closely  re- 
semliling  those  of  the  renal  ealeulus,  might  sometimes  be  traced 
to  the  stomach. 

Ml.      Henry  L — ,  a  lithe  active  Scotchman  with  golden  hair,  ap- 
parently 1.  .Hid  m.  on  his  return  South  after  grouse-shouting  in  the 


190  ABDOMINAL    PAIXS. 

autumn  of  1866,  began  to  suffer  from  pain  in  the  loins.  This  got  better  with- 
out any  special  medication,  but  about  Christmas,  when  tossing  a  child  up  in 
the  air,  he  felt  a  sudden  stab,  as  it  were,  in  the  right  loin,  so  sharp  thut  he 
was  within  an  ace  of  dropping  the  child.  The  pain  in  this  situation,  some- 
times better,  sometimes  worse,  but  never  absent,  continued  up  to  the  time  of 
his  coming  to  me  February  8th,  1867.  Very  often  the  pain  ran  sharp  down 
into  the  front  part  of  the  pelvis,  there  was  an  ache  in  the  right  testicle,  and 
that  organ  was  strongly  retracted  against  the  body.  He  had  been  treated  by 
a  first-rate  surgeon  with  Alkalies,  Alkaline  Mineral  Waters,  and  with  Iodide 
of  Potassium  and  Turkish  baths  without  success.  Indeed  he  thought  he 
grew  worse. 

On  examination  there  was  pain  on  pressure  with  a  finger  just  below  the  ribs 
outside  the  psoas  muscle  on  the  right  side. 

The  urine  was  pale,  just  acid,  of  the  specific  gravity  only  1.006,  probably 
from  the  joint  influence  of  the  alkalies  and  a  habit  of  taking  a  glass  of  whiskey 
toddy  at  bedtime  in  lieu  of  wine  at  dinner. 

Treatment  prescribed,  February  8. — To  wear  a  belt  with  loin  stifieners.  to 
take  port-wine  at  dinner,  and  a  nap  on  the  sofa  before  the  meal.  At  11  and 
4  o'clock  daily  to  take  a  couple  of  grains  of  Quinine. 

On  the  12th  the  spec.  grav.  of  the  urine  examined  was  1.025.  On  the  23d 
the  pain  in  the  back  was  to  be  elicited  by  very  hard  pressure  only.  With 
some  Iodide  of  Potass  added  to  his  mixture  (I  forget  why)  he  was  dismissed 
with  orders  to  continue  the  treatment  for  a  week.  After  that  he  wanted  no 
more  doctoring  for  a  time. 

But  at  the  beginning  of  April  he  dined  out  twice  running,  and  indulged  on 
each  occasion  in  the  fermenting  mixture  which  London  dinner-givers  are  fain 
to  call  Champagne,  and  the  consequence  was  a  return  of  the  peculiar  lumbar 
pain,  though  the  urine  remained  quite  natural.  I  prescribed  for  him  a  return 
to  the  former  prescription.  This  was  in  passion  week.  On  Easter  Monday 
he  still  felt  the  pain,  but  like  a  true  patriot  joined  his  corps  at  the  Volunteer 
Review.  The  reward  has  been  a  complete  cure  of  his  pain.  Now,  had  it 
been  rheumatic  or  renal,  as  might  have  been  suspected,  or  anything  else  but 
abnormally  placed  pains  of  indigestion,  it  is  clear  that  reviewing  on  the  Dover 
Downs  in  English  spring  weather  would  have  made  him  worse. 

The  retention  of  feces  in  the  bowels  is  frequently  assigned  by 
the  public  as  a  cause  of  pain  in  the  epigastrium.  Their  fond- 
ness for  purgatives  doubtless  often  leads  to  error  on  this  head, 
but  still  I  do  think  they  are  sometimes  right,  and  that  the  mere 
retention  in  the  colon  and  rectum  of  matters  ready  for  evacua- 
tion may  give  rise  to  considerable  pain  in  the  epigastrium.  It 
is  not  very  easy  to  hit  upon  a  good  illustration  of  this,  for  most 
usually  costiveness  and  even  constipation  depend  on  some 
morbid  condition  of  the  stomach  or  of  the  whole  alimentary 


ABDOMINAL    PAINS.  191 

1  or  of  the  whole  body,  and  it  ia  difficult  to  separate  the 

s  of  the  retention  from  those  of  the  condition  which  1ms 

•idem!  it.     Thus,  for  example,  you  will  find  that  nearly  all 

the  chronic  cases  quoted    in   the   first  chapter   had   confined 

bowels,  but  no  one  would  attribute  the  epigastric  pains  to  that 

cause,  seeing  that  an  obvious  indigestion  existed  in  the  stomach, 

oat  of  those  pains.     In  the  following  case,  however,  the 

•  of  the  retention  of  the  feces  was  quite  extraneous,  and 

there  was  no  proof  of  anything  being  the  matter  with  the 

digestive  organs. 

X  III. — Anne  M — ,  aged  23,  a  domestic  servant,  was  admitted  to 
St.  Mary's  October  15th,  1856,  complaining  iu  various  parts  of  the  body  of 
obscure  pains,  which,  however,  after  admission,  set-med  tu  have  their  definite 
seat  in  the  epigastrium,  and  to  be  worst  always  after  food.  She  had  palpita- 
tion of  the  heart,  nausea,  and  a  tendency  to  faint  Her  face  was  flushed,  the 
skin  hot,  and  the  tongue  coated ;  but  otherwise  her  aspect  was  healthy.  After 
a  few  days  the  nurse  observed  that  her  linen  was  stained,  and  the  patient  her- 
self stated  that  she  had  a  vaginal  discharge.  But  actual  examination  found 
the  organs  of  generation  quite  normal,  and  that  the  pus  came  from  a  small 
papilla,  the  remains  of  an  old  haemorrhoid,  on  the  edge  of  the  anus.  This 
was  exquisitely  sensitive,  and  the  patient  confessed  that  she  had  voluntarily 
retained  her  feces  on  account  of  the  pain  which  defecation  gave  her.  Warm 
liaths  and  sui'tenin.i:  eiiemata,  with  the  aid  of  Valerian  draughts,  reduced  the 
hypeni-.-the-ia,  and  with  the  emptying  of  copious  solid  stools  from  the  coloa 
the  pain  at  the  epigastrium  ceased,  and  she  got  good  rest  at  night. 

In  cases  of  misplaced  pains,  I  mean  pains  not  in  the  locality 
of  the  parts  truly  affected,  Valerian  is  a  very  useful  medicine. 
Its  calmative  effect  on  the  nervous  system  is  remarkable.  That 
was  the  reason  of  its  administration  to  this  young  woman.  It 
would  have  been  cruel  to  forcibly  open  her  bowels  by  purga- 
-.  without  first  deadening  the  abnormal  sensitiveness  which 
hail  eau.-e«l  her  to  con.-tipate  them. 


192 


CHAPTEE    Y. 

VOMITING. 

SECTION  1. — General  remarks  on  the  physiology  of  the  process.  SECTION  2. — 
Vomiting  of  pus.  SECTION  3. — Vomiting  of  mucus.  SECTION  4. — Vomiting  of 
blood.  SECTION  5. — Acid  fermentation  of  vomit.  SECTION  6. — Fecal  vomiting. 
SECTION  7. — Vomiting  of  unchanged  food.  Hysterical  vomiting.  SECTION  8. — 
Vomiting  in  pulmonary  consumption.  SECTION  9. — Occasional  causes  of  vomit- 
ing. SECTION  10. — Sea-sickness.  SECTION  11. — Review  of  remedies  employed. 

SECTION    I. 
General  remarks  on  the  physiology  of  the  process. 

IN  the  normal  passage  downwards  of  food  the  involuntary 
nerves  and  muscles  of  the  fauces,  the  gullet,  and  of  the  stomach 
are  in  vigorous  action ;  whilst  the  voluntary  abdominal  muscles 
and  the  diaphragm  exert  no  influence  over  the  digestive  canal. 

In  vomiting  a  converse  condition  exists — the  involuntary 
oasophagus  is  wholly  or  partially  paralyzed  and  relaxed,  the 
involuntary  peristaltic  wave  of  the  stomach  ceases,  and  at  the 
same  time  .the  diaphragm  and  abdominal  muscles  are  degraded 
from  agents  of  volition  to  purely  automatic  instruments. 

The  ceasing  of  the  peristaltic  wave  allows  the  pylorus  to  close. 
It  is  converted  from  a  portal  somewhat  stiffly  held  open  by  the 
circular  fibres  (as  if  in  a  sort  of  erection)  into  a  collapsed  valve. 
The  pylorus  being  closed  and  the  cardia  open,  it  would  not 
require  any  such  very  strong  muscular  effort  to  empty  the 
stomach. 

But  the  muscles  thus  abnormally  perverted  into  compressing 
the  stomach  are  very  large  and  powerful.  Hence  vomiting  is  a 
violent  and  explosive  act. 

In  spite,  however,  of  the  violence  and  explosiveness,  a  correct 
pathology  must  look  upon  vomiting  as  a  lowering  of  the  vital 
powers,  as  an  atony  of  the  digestive  tube  and  its  appendages, 


VOMITI  193 

when  the  fac'  ;t   in  tlio  order  and  light  above  sketched 

out. 

Thus  it  becomes  clear  why  vomiting  is  an  accompaniment  of 

:i   which  there  is  a  diminution,  or  arrest,  or 

of  muscular  action.     Unusual  or  too  long-continued 

bodily  exertion,  exposure  in  cold  or  heat,  and  such  like  circum- 

cculiarly  exhaustive  of  muscular  and  nervous  power, 

re  eating  even  a  moderate  meal,  will  in  some  persons  c 

ted. 

The  same  result  follows  in  fainting,  or  when,  from  excessive 

mental  emotion,  the  nerves  of  the  gullet  experience  a  temporary 

paralysis:  so   that    vomiting  is  produced   by  disappointment, 

anxiety,  nay  sometimes  even  by  sudden  joy  and  pleasure.     Still 

strikingly  is  it  brought  on  by  structural  disease  of  the 

stomach,  by  which  the  peristaltic  wave  is  arrested,  or  at  least 

interfered  with.     Or  by  a  stoppage  of  the  same  in  the  intestines, 

such  as  occurs  in  ileus,  hernia,  intussusception,  and  peritonitis. 

Vomitii  g    in  these  latter  cases  has  been  sometimes  referred 

to  a  reversal  of  that  muscular  act  which  carries  the  alimentary 

onwards — to  an  awft'-peristaltic  motion.     But  there  seems 

t<>  me  no  evidence  that  such  is  the  case;  indeed,  an  attentive 

leration  of  the  phenomena  of  the  act  itself  would  seem  to 

>  the  contrary.     Observe  peristaltic    motion — it  is 

.  continuous,  and  uniform  ;  po  indeed  strength  in  its 

.  but  no  irresistible  impetus.     Compare  the 

:md   note  the  diil'erence:  in  vomit  in  _  .ive  a  violent 

explosive  power,  like  a  force-pump,  throwing  the  ejected  m. 

out  to  a  considerable  distance.     Can  there  be  a  greater  contrast 

•en  two  acts  of  the  same  part  ?     The  explanation  given 

•h  more  nai  iraliy  to  suit  tin-  phenomena. 
In  son"  ifl  in  vomiting  from  cere- 

bral diseases  of  a  \^i.  .      In   others  it  appears  to 

\ample  in  the  action 

•••ndariiy 

on  the  limbs;  and   possibly  in  some  it  may  be  entirely  local — 
an  approach  to  which   is  made   in  the  quickly  acting  em 
such  as  Sulphate  of  Zinc,  wl, 
depression   than    mo>t   other  mc.i 
ii  all   th 

L8 


19-i  VOMITING. 

state  in  vomiting  to  be  one  of  relaxation  or  atony,  and  to  view 
as  the  main  muscular  manifestation  of  atony  in  the  stomach  a 
tendency  to  vomit. 

Vomiting  seems  less  dependent  upon  the  previous  or  chronic 
condition  of  the  stomach,  and  more  upon  the  idiosyncrasy  of  the 
individual,  than  any  of  the  phenomena  already  discussed.  There 
are  dyspeptics  who,  whatever  may  be  the  matter  with  them, 
never  throw  up  their  food ;  whilst  others  do  so  on  the  slightest 
occasion.  Even  pleasant  associations  will,  in  some  people,  bring 
on  this  most  unpleasant  consequence ;  an  occasional  patient  of 
mine,  a  healthy  young  lady,  has  been  sometimes  taken  with 
retching  on  entering  a  ball-room  where  she  expects  an  agreeable 
evening,  whilst  it  never  happens  in  going  to  a  stupid  party. 
On  the  other  hand,  I  have  had  a  patient  with  cancer  of  the 
stomach,  and  others  with  various  sorts  of  severe  dyspepsia,  who 
could  take  the  most  repulsive  drugs  without  inconvenience. 
The  mere  fact  of  vomiting,  therefore,  affords  in  itself  no  clue  to 
the  local  condition  of  the  stomach.  But  the  time  of  its  occur- 
rence, the  circumstances  which  increase  it,  and  the  nature  of 
the  matters  thrown  up,  may  be  most  suggestive  to  the  practi- 
tioner. 

Vomiting  when  the  stomach  is  empty,  or  that  which,  though 
it  accidentally  occurs  at  other  times,  is  most  frequent  and  dis- 
tressing then,  may  be  safely  set  down  as  arising  not  from  any 
fault  of  the  viscus  itself.  Such  is  the  morning  sickness  frequent 
in  pregnant  women,  and  in  cases  of  diseased  heart,  of  abdominal 
tumor,  and  sometimes  of  pulmonary  consumption.  This  has 
been  explained  as  a  reflex  action  of  the  vagus  nerve  excited  by 
the  irregular  irritation  of  some  of  its  branches;  and  on  the  same 
principle  may  be  interpreted  the  more  rare  cases  where  it  has 
been  caused  by  foreign  bodies  in  the  ear  or  nose,  by  tumors  in 
the  neck,  &c. 

When  it  occurs  with  a  full  stomach,  we  may  reckon,  as  a 
general  rule,  that  the  smaller  the  quantity  of  food  that  produces 
it,  and  the  sooner  it  takes  place  after  eating,  the  nearer  to  the 
mouth  is  the  cause.  An  ulcer  of  the  oesophagus  causes  rejection 
of  the  food  before  it  has  got  down ;  of  the  cardia,  or  smaller 
curvature,  very  soon  after  it  has  got  down ;  and  a  similar  lesion 


VOMITING.  195 

of  the  pylorus  or  liver,  after  an  interval  sometimes  of  several 
hours. 

When  vomiting  arises  from  the  paralysis  of  the  oesophagus 
vlm-1 1  is  induced  by  a  congestion  of  the  brain,  as  in  apoplexy 
or  drowning,  or  by  poisoned  nerve,  as  in  dead  drunkenness,  it 
is  increased  by  the  hori/.ontal  posture;  when  it  arises  from  de- 
ficient supply  of  blood,  as  in  i'ainting  and  anaemia,  that  same 
ion  relieves  it.  Sea-sickness  also  is  often  warded  oli'  by 
lying  down  with  the  head  low. 

The  contents  of  vomit  may  often  afford  valuable  indications 
to  the  practitioner,  and  will  appropriately  divide  into  cl: 

he  meets  with.     They  will  here  serve  the  purpose  of 
the  headings  of  sections. 

SECTION   II. 
/  of  pus. 

XI V.— Klizabeth  S — ,  aged  25,  was  admitted  at  St.  Mary's  Janu- 
ary 'J.".d,  l-.vj.     sin-  IKK!  suffered  for  three  months  from  vomiting,  at  first 
,.>nal,  tint  latterly  :it  every  meal,  so  that,  in  spite  of  a  good  appetite  and 
plenty  to  eat,  she  had  grown  pale  and  thin.     After  this  had  continued  u 
mouth,  she  began  to  experience  a  difficulty  in  swallowing,  which  has  gradu- 
ally ii.  -lionuh  tin-  pain  caused  by  it  is  not  so  great.    The  mouthful 
seemed   to  lodge  somewhere  at  the  back  of  the  manubrium  of  the  sternum, 
and  either  to  l>e   rejected  or  retained  with  great  pain,  which  ran  through  to 
a  >pot   In  twi  i  n  the  shoulders.     Besides  this,  she  used  to  have  occasional 
ag  and  occa.-ional  vomiting  of  glairy  and  frothy  matter,  with  opaque 

:   pus  in  it  not  unlike  the  sputa  of  early  phthisis. 

(Iruel.  arrowroot,  cocoa,  raw  eggs,  and  milk  were  swallowed  and  kept  down, 
so  that  >ln  -ionally  uot  sick  for  a  day  or  two  together.  l>ry  Kismuth 

powd'  o  kept   down,  and   thought   they  relieved   the  pain.     But  Sul- 

pliatc  of  Copper  made  her  vomit  on  each  occasion  that  it  was  tried,  as  was 
done  M-vcral  times  with  the  idea  of  stimulating  the  ulcerated  surface  to  healing 
action. 

At  length  she  seemed  to  catch  a  cold  on  the  chest,  and  died  suddenly  after 

>t'a>t  one  morning. 

On  examination  after  death  its  immediate  cause  was  found  to  be  the  opening 
of  a  fistulnu-  communication  |,etween  the  ulcerated  surface  of  the  (r.-oplia-u-s 
and  the  pericardium,  l»y  which  pus  and  food  had  made  their  way  into  the 
serous  sac. 

The  stomach,  &c.,  were  healthy. 

The  pus  iii  the  vomit  me  from  the  cellular 


196  VOMITING. 

tissue  around  the  oesophagus,  which  was  being  eaten  through 
by  the  fistula. 

Eemark  in  passing  the  use  of  which  Bismuth  seemed  to  be  to 
the  raw  surface.  Some  persons  have  found  it  of  equal  use  in 
phthisical  diarrhoea  from  ulcerated  bowels.  I  confess  I  find  it 
in  this  latter  disease  less  efficient  than  Sulphate  of  Copper;  but 
in  the  upper  part  of  the  digestive  canal  the  comparative  force 
of  the  two  drugs  would  seem  to  be  reversed.  Another  instance 
of  the  use  of  Bismuth  in  ulcerated  oesophagus  will  be  quoted 
afterwards  (CASE  CCVI).  I  felt  considerable  satisfaction  that 
this  poor  woman  never  had  any  probang  put  down  her  throat. 
It  would  have  thrown  no  light  upon  the  diagnosis,  and  might 
have  gone  into  the  pericardium  and  been  the  cause  of  death. 
Imprimis  non  nocere  is  the  first  commandment  in  medical  morals. 

CASE  CLXV. — James  G — ,  aged  32,  dairyman,  admitted  to  St.  Mary's 
June  27th,  1856,  after  an  illness  of  a  month,  during  which  he  had  attended 
as  an  out-patient.  He  complained  of  soreness  of  throat  and  of  difficulty  of 
swallowing  solids.  He  said  he  never  vomited,  but  after  admission  he  beg;\u 
to  throw  up  a  considerable  quantity  of  pinkish  or  flesh-colored  purulent 
matter.  Sometimes  it  was  ejected  by  retching,  sometimes  with  less  effort. 
There  was  nothing  abnormal  to  be  seen  or  felt  in  the  fauces  or  upper  part  of 
the  oesophagus.  After  he  had  been  in  for  a  fortnight  a  small  tumor  of  carti- 
laginous density  was  felt  behind  the  ramus  of  the  jaw,  just  below  the  right 
ear.  During  the  time  he  remained  in  hospital  he  had  a  Laurel  leaf  poultice 
to  the  neck  and  Cod-liver  Oil;  but  as  no  conscientious  hope  of  future  amend- 
ment could  be  expressed,  it  was  not  thought  right  to  occupy  the  much-wanted 
space  in  the  ward  with  an  incurable  case,  and  so  I  lost  sight  of  him. 

There  could  be  but  one  end  to  what  was  indubitably  a  can- 
cerous ulceration  of  the  oesophagus,  and  I  do  not  think  a  hos- 
pital ward  is  the  happiest  place  in  which  to  await  that  end  ;  so 
neither  for  the  patient  nor  the  public  do  I  think  it  right  to 
retain  such  cases  in  a  charitable  institution.  It  is  quite  different 
where  any  doubt  exists  about  the  diagnosis. 

CASE  CLXVI. — Edward  J — ,  aged  56,  greengrocer,  was  admitted  into  St. 
Mary's  November  16th,  1857,  complaining  of  pain  in  the  left  side  of  epigas- 
trium immediately  after  eating.  This  was  relieved  by  vomiting.  His  illness 
had  first  come  on  during  a  voyage  to  America  the  previous  April.  Previous 
to  that  he  had  always  enjoyed  good  health,  and  weighed  12  stone;  but  now 
he  was  reduced  to  9  st.  2  Ib.  His  vomit  usually  consisted  of  his  food ;  but 


VOMITINTr.  197 

on  on-  'la  quantity  of  creamy  pus  mixed  with  a  strongly 

arid  Huid. 

A  hard  tuumr  >vered  below  the  cartilages  of  the  ribs  on  the  left  ' 

side. 

He  left  the  hospital  December  14th,  probably  dissatisfied  at  the  little  relief 
it  was  possible  to  give  him. 

These  are  the  only  cases  I  can  find  where  there  was  pus  in 
the  vomit,  viz.,  common  ulceration  of  the  oesophagus,  cancer  of 
the  Gjsophairus,  cancer  of  the  cardia.  It  does  not  appear  to  be 
thrown  up  in  common  ulceration  of  the  stomach,  still  less  in 

rh  of  the  stomach.  The  gastric  and  cesophageal  mucous 
w;ills  are  very  different  from  the  bladder  or  urethra.  These 
secrete  pus  on  the  slightest  irritation  ;  an  undue  stretching,  a 
hard  substance,  however  smooth,  an  essential  oil,  moderate 
alkalinity  of  the  urine,  the  infection  of  a  catarrh  so  weakly  poi- 
sonous as  gonorrhoea,  and  other  equally  mild  forces,  arrest  their 
vitality  down  to  the  pyogenic  stage.  The  fauces,  gullet,  and 
stomach  are  much  tougher  ;  fortunately  indeed,  for  if  stretching, 
hanl  substances,  spicy  oils,  alkalies,  or  acids  hurt  them,  or  if 
moderate  doses  of  morbid  or  common  poisons  acted  on  them 

'  y,  who  would  insure  a  man's  life  for  a  week  ?  To  purulent 
inflammation  they  are  not  prone,  and  therefore  we  cannot  expect 
to  find  pus  in  that  which  is  ejected  from  them  in  their  usual 

ises.  When  there  is  pus  in  vomit,  either  a  malignant 
tumor  has  destroyed  the  walls  and  taken  their  place,  or  there 
is  an  u  It-.  .-rat  ion  with  adhesions  into  the  surrounding  cellular 
tissue. 

Care  should  be  taken  to  ascertain  the  condition  of  the  lungs, 
and  make  sure  that  the  pus  does  not  come  from  a  vomica,  the 
emptying  of  which  will  sometimes  be  accompanied  by  vomiting. 

SECTION   III. 

»'fi'ny  of  mm 
Murus  is  found  in  the  vomit  in  what  is  called  English  cholera, 


or  acute  sumnuT  irastrir 

X.VII.-  Kdmiind  K  —  .  aired  Irt,  was  found  by  a  policeman  at  half- 

.v  in  tin-  ni'iriiiiii:  of  Septeiiiiier  -ttli.  I  -.">!.  staggering  some 

ji.ilinir-i.  and  unalde  to  walk,  from  a  violent  pain  in  the  liclly.  whirli  had  sn.l- 

'.;cd  him  on  the  way  to  work.      !!••  was  taken  to  St.  Mary's,  and 


198  VOMITING. 

kept  vomiting1  mucus  and  bile  all  day.     The  pulse  was  90,  the  tongue  dry. 
Pain  on  pressure  of  the  epigastrium. 

No  collapse,  cramps,  or  retention  of  urine  occurred.  He  had  a  dose  of 
Calomel  immediately,  followed  by  diarrhoea;  a  dose  of  Opium  at  night;  and 
was  discharged  well  next  day. 

The  green  matter  in  the  vomit  of  these  acute  attacks  is  shown 
to  be  bile  by  its  bitter  taste  to  the  patient,  and  sometimes  by  its 
smell  to  the  bystanders.  The  presence  of  bile  is  a  proof  of  pre- 
vious health,  and  an  assurance  that  the  cause  which  is  disturb- 
ing it  is  a  temporary  one,  however  severe  it  may  be,  and  that 
the  vitality  is  not  deeply  smitten.  You  do  not  see  it  in  the 
vomiting  of  chronic  disease,  you  do  not  see  it  in  that  of  fatal 
epidemic  cholera ;  but  you  do  see  it  thrown  up  by  the  hearty 
landsman  who  is  roaring  over  the  gunwale  of  a  Channel  steamer, 
and  it  is  hailed  as  a  good  sign  in  a  convalescent  from  cholera 
collapse.  Give  an  emetic  to  a  healthy  man,  and  you  see  plenty 
of  bile ;  give  it  to  a  broken  invalid,  and  you  most  likely  will 
not.  Bile,  then,  is  to  be  looked  upon  as  a  bird  of  good  omen. 
It  is  regurgitated  from  the  liver  into  a  fairly  healthy  stomach, 
and  not  into  an  unhealthy  one. 

Mucus,  mixed  also  with  bile,  is  thrown  up  in  those  less 
severe  exhibitions  of  gastric  disorder  which  are  called  "  biliou.- 
attacks." 

CASE  CLXYIII. — John  D — ,  a  retired  schoolmaster,  aged  55,  became  my 
patient  February  7th,  1863.  For  at  least  ten  years  he  had  been  subject  to 
"  bilious  attacks,"  occurring  in  the  winter,  and  generally  half-a-dozen  times 
each  season.  He  described  them  as  commencing  with  a  hawking  up  of 
phlegm ;  which  phlegm  did  not  seem  to  come  from  the  air-passages,  but 
from  the  gullet.  This  usually  took  place  of  a  morning ;  and  in  the  evening  a 
severe  attack  of  headache  came  on,  and  a  vomiting  of  phlegm  and  bile.  He 
came  to  me  because  he  found  them  getting  more  frequent  and  severe,  and 
because  he  began  to  doubt  if  the  traditional  mode  of  treating  them  with 
purgatives  were  really  the  best.  I  put  him  on  Quinine  and  Strychnine,  and 
saw  him  again  on  the  23d.  He  said  that  in  the  meanwhile  he  had  been 
threatened  with  a  bilious  attack,  but  it  had  been  warded  off,  he  thought,  by 
the  medicine.  I  heard  of  him  in  1866  from  a  relative  as  a  much  heartier  man 
than  he  used  to  be. 

The  summer  gastric  disorders,  which  I  first  exampled,  are' 
probably  brought  on  by  the  absorption  into  the  body  of  some 
poison  diffused  through  the  air  or  water,  and  which,  when  wide- 


VOMIT1  199 

1  ami  intense,  constitutes  the  terrible  epidemic  cholera. 

fall  on  the  robust  equally  often  with  the  weakly.     These 

winter  liilions  attacks  are   more  like  what  we  called  "  catching 

enM."  ami  are  certainly  induced  by  changes  of  temperature  in 

damp  climates.     Like  colds  in  the  head  or  chest,  they  aft'ect 

delicate-formed  and  delicate-coristitutioned  persons  principally. 

Much    may   be   done,  therefore,  to  ward  off  the  attacks    by 

strengthening  the  constitution.     Quinine  and  Strychnine  is  the 

treatment ;  purgatives  do  harm.    I  say  purgatives  do  harm, 

tse  an  unprofessional  friend  of  mine,  who  used  formerly  to 

artem  antiquam,  finds  even  homoeopathic 

than  purgatives;   and   restorative   treatment 

would  be  still  better  than  homoeopathic,  would  she  but  try  it. 

Another  thing  which  seems  to  me  a  broad  hint  against  pur- 
gatives for  "  bilious  attacks"  (by  which  I  mean  attacks  of  gastric 
catarrh  in  a  body  healthy  enough  to  eject  bile  by  vomiting)  is, 
that  where  there  is  purging  arising  without  the  aid  of  drugs, 
the  sickness  lasts  much  longer  than  if  there  is  none.  He  must 
be  indeed  a  devoted  admirer  of  the  pharmacopoeia  who  imagines 
that  the  artificial  diarrhoeas  excited  by  its  help  can  do  good 
where  nature's  diarrhoeas  do  harm.  Compare  the  more  usual 
forms  of  bilious  attack,  of  which  I  have  quoted  examples,  with 
the  following: — 

CI.XIX.—  Kli/.alieth  J — ,  a  domestic  servant,  aged  32,  came  in' 
Mary's  October  18th,  1855.  Since  the  first  week  of  the  month  she  had  com- 
plained «>f  headache  and  weiirlit  at  the  epigastrium,  and  on  the  loth  was 
.-ri/ed  with  diarrlura.  which  still  continued,  though  less  severe  than  at  first. 
On  the  ITtti  she  was.  in  addition,  attacked  with  pain  in  the  epigastrium  and 
vomiting,  which  was  very  frequent  on  admission.  The  pain  waf  much  relieved 
\>\  mustard  cataplasms.  The  toiiirue  was  red  and  clean,  the  pulse  weak  and 
quick.  The  millions  were  gp-en,  and  the  vomit  was  ^iveii  too,  with  shreds  of 

mucus  stained  with  port  wine  that  had  I n  administered  to  her. 

The  vomiting  was  somewhat  appeased  ]>\  Hydrocyanic  Acid  in  effervescing 

draughts ;  and  she  also  took  some  Chalk  and  Opium,  with  a  little  gray  Oxide 

rcury  in  it.      P.ut  tin-  vomiting  did  not  cease  till  the  'JOtli.  after  which 

she  liciran  to  amend,  a-ked  for  food,  and  was  able  to  get  up  on  the  22d,  and 

•:•  home  on  the  'Ji'.ih. 

<  I. X  . \.-Anne  C  .  ai_'..,l  t'.i.  was  admitted  July  :Ust.  \^:>~.  She 
had  been  in  her  usual  Lr"od  health  up  to  a  month  previously,  when  she  caught 
(•old  from  exposure,  and  distrcs.-ini:  naii-ea  and  vomiting  en-ued.  which  in  a 
few  hours  Was  followed  liy  purging:  the  stools  being  watery,  I'm  thy.  and  live 


200  VOMITING. 

from  offensive  odor.  The  skin  then  was  cool,  her  tongue  clean,  the  pulse  85. 
The  purging  continued  at  the  rate  of  four  motions  daily.  She  vomited  after 
each  attempt  to  eat;  the  ejecta  being  green  and  yellow,  mixed  with  clots  of 
mucus  and  undigested  food. 

The  patient  had  also  considerable  anasarca  of  the  lower  extremities,  and 
she  suffered  from  palpitations.  The  force  of  the  heart  was  weak,  but  the 
sounds  natural,  and  the  lungs  healthy. 

She  was  treated  without  drugs,  but  had  five  grains  of  Pepsine  powder  three 
times  daily,  half  a  pint  of  beef-tea,  and  milk  diet  guarded  with  lime-water, 
food  being  administered  in  small  quantities  every  three  hours. 

By  the  8th  of  August  she  was  so  much  better  in  all  respects,  that  she  was 
able  to  eat  mutton  chop,  and  to  take  a  grain  of  Quinine  dissolved  in  Tartaric 
Acid  three  times  a  day. 

On  the  12th  she  had  the  full  hospital  diet.  The  bowels  having  become 
costive^an  Aloes  and  Myrrh  pill  was  ordered  every  night. 

On  the  15th,  there  being  still  some  pain  at  'the  epigastrium  complained  of, 
the  solid  diet  was  reduced  to  half,  and  a  pint  of  beef-tea  given  for  supper. 

There  was  also,  on  the  17th,  a  threatening  of  return  of  diarrhoea;  but  it 
was  promptly  stayed  with  Chalk  mixture,  and  she  was  discharged  well  on 
the  19th. 

Eemark  how  in  the  first  of  these  two  cases  the  preceding 
diarrhoea  did  not  prevent  the  occurrence  of  stomach  symptoms, 
and  how  long  they  endured  in  the  second  case  where  the  diar- 
rhoea had  come  on  at  the  same  time. 

I  abstained  from  perturbative  practice  during  the  height  of 
the  disorder,  not  out  of  scepticism  in  the  pharmacopoeia,  but 
the  contrary ;  there  was  no  physical  condition  capable  of  estab- 
lishment by  its  means  which  I  would  induce. 

The  costiveness  of  the  bowels  after  a  natural  diarrhoea  is  a 
very  usual  reaction.  Had  astringents  been  given,  one  might 
have  attributed  it  to  them. 

The  weakness  of  this  patient  was  shown  by  the  anasarca ;  but 
we  had  no  reason  to  suppose  that  there  was  any  chronic  de- 
generation of  the  viscera,  or  she  would  have  been  retained  in 
hospital. 

In  the  next  case  the  character  of  the  disease  is  much  more 
chronic. 

CASE  CLXXI. — Helena  F — ,  a  domestic  servant,  aged  40,  February  25th, 
1858.  Since  the  beginning  of  December  she  had  complained  of  uneasiness' 
at  the  epigastrium  after  meals,  accompanied  by  nausea.  Six  weeks  before 
admission  she  began  to  relieve  the  feeling  of  weight  by  vomiting  her  food 
several  times  a  day,  and  in  the  morning  to  vomit  frothy  and  stringy  matter 


VOMITING.  201 

onally  streaked  with  blood.    She  never  threw  up  any  riots  of  blood,  ami 

alwa\s  iif  ;t  d;irk  color.     Siiu-c  her  illness  the  catamenia  had  cea.-ed. 

having  been  previously  copious  and  painful;  she  had  got  very  much  emaciated. 

and  in  good  truth  she  presented  an  aspect  closely  resembling  that  of  pulmo- 

nary rnii.-umption.     Hut  stethoscopic  examination  of  the  chest  showed  it  to 

:ie  healthy,  and  she  had  no  cough. 

The  absence,  however,  of  cough  is  no  proof  of  the  absence  of 
pulmonary  lesions  in  the  sort  of  case  which  at  first  blush  hers 
•  tl  to  resemble.     For  instance  — 

\  XII.—  Mr.  J.  P—  came  to  me  May  30th.  1860,  complaining  of 
flatulence,  and  of  uneasiness  without  pain  in  the  epigastrium,  and  of  having 

i  •  musciilarly  weak  and  nervous.  He  frequently  threw  up,  as  he  said. 
from  the  stomach,  stringy  mums  especially  after  eating.  But  it  was  not 
mixed  with  food  in  ireneral.  He  had  no  cough.  He  remained  under  my  care 
till  the  10th  of  June,  when  I  examined  his  chest  and  was  obliged  to  tell  him 
that  I  found  bronchophony,  crackling  rales,  and  dulness  on  percussion  at  the 

..f  one  lung,  He  seemed  dissatisfied  with  the  diagnosis,  and  I  did  not 
have  another  v. 

T  should  like  to  have  made  out  for  sure  whether  the  mucus 
really  came  from  the  stomach,  or  whether  it  was  the  contents  of 
the  bronchi  thrown  up  by  a  nauseating  effort  instead  of  a  cough. 
Vomiting  certainly  does  occur  in  phthisis,  and  the  vomit  con- 
tains mucus.  But  that  mucus  is  also  often  purulent,  which 
gastric  mucus  rarely  is,  so  that  it  is  probably  swallowed  or 
ejected  from  the  bronchi  by  the  emetic  strain. 

Such  cases  as  the  last  should  remind  us  always  to  examine 
the  chest,  cough  or  no  cough,  in  any  forms  of  disease  which  are 
ever  assoeiat'-d  with  consumption.  And  the  only  way  to  guard 
oneself  from  the  imputation  of  mistaking  the  disease  is  to  declare 
tin-  diagnosis  to  somebody  at  once,  for  the  patient  will  often 
break  down  very  suddenly  while  you  are  casting  about  for  an 
opportunity  of  letting  his  state  be  known. 

SECTION  iv. 
I"  uiitinrj  of  bio 


The  immediate  symptoms  diiV-Tin^  from  ordinary  vomiting 
whieh  precede  and  ai-e.omjiany  the  vomiting  of  blood  aiv 
scribed  in  the  annexed  e;: 

CV-K  ri.XXIII.     May  nth.  HI','.'.      \Ir~.  II—  .aired  •!->.  uw,.k«-  at  two  in 
the  morning,  feeling  very  hot  and  resiles.-:  a  sudden  faintness  and  dread  came 


202  VOMITING. 

ovor  her;  she  felt  pick ;  the  sickness  felt  somewhat  better,  and  she  got  out  of 
bed.  Almost  immediately,  if  not  in  the  very  act  of  rising,  a  flood  of  blood  or 
bloody  fluid  gushed  up  from  the  stomach.  She  had  not  previously  considered 
herself  an  invalid,  but  had  for  several  months  had  irregular  catamount,  and 
for  three  days  before  her  attack  had  experienced  a  dull  pain  at  the  epigastrium 
and  right  shoulder.  On  examination  of  the  epigastrium,  it  was  painful  on 
pressure,  but  not  one  spot  more  than  another.  A  feeling  of  nausea  was  ex- 
cited by  the  examination,  and  also  by  taking  food.  The  tongue  was  somewhat 
dry.  She  did  not  bring  up  her  food  ;  not  even  when  the  swallowing  a  cup  of 
hot  tea  suddenly  (on  the  16th)  had  caused  her  to  retch  violently. 

A  pill  was  administered  on  the  13th  containing  four  grains  of  Acetate  of 
Lead,  and  on  the  14th  she  was  ordered — 

R. — Acidi  Sulphurici  diluti  n^xx, 
Olei  Terebinthinae  rr^x, 
Infusi  Hoematoxyli  fl5j,  ter  die — 
and  had  no  return  of  vomiting. 

CASE  CLXXIV. — James  P — ,  aged  37,  was  admitted  into  St.  Mary's  Hos- 
pital May  4th,  1860.  He  had  been  long  subject  to  vomiting,  and  had  five 
times  vomited  blood,  for  the  last  time  the  night  before  admission.  The  blood, 
he  said,  always  came  up  with  a  sudden  gush,  and  was  dark  in  color.  He  de- 
scribed the  symptoms  preceding  the  haamatemesis  as  commencing  with  head- 
ache and  pain  in  the  right  side ;  after  this  he  felt  heavy  and  drowsy ;  then  he 
got  giddy ;  and  then  the  blood  came  up. 

The  tongue  was  dry  and  furred,  the  pulse  92  and  bounding.  The  pulsation 
of  the  aorta  in  the  epigastrium  was  very  distinctly  felt. 

(Further  particulars  of  the  history  of  this  man  may  be  found  at  page  109, 
where  his  case  is  repeated  on  another  account.) 

The  above  are  the  ordinary  symptoms  which  occur  without 
prognosticating  any  immediate  danger.  When  a  fatal  result  is 
to  be  feared,  they  are  more  severe. 

CASE  CLXXV. — Hannah  H — ,  aged  48,  a  cook,  was  admitted  to  St.  Mary's 
June  24th,  1852,  for  haematemesis.  She  said  she  had  brought  up  a  great 
quantity  of  fluid  blood  the  day  before,  and  that  while  she  was  throwing  it  up 
she  felt  complete  inability  to  move  her  limbs. 

While  in  the  hospital,  between  that  date  and  July  3d.  she  several  times 
vomited  blood,  the  vomiting  always  coming  on  quite  suddenly  without  previous 
warning,  but  being  followed  by  deadly  faintness  and  by  an  increased  pallor  of 
face.  On  the  last-named  day,  as  the  house-surgeon  was  going  his  morning 
rounds,  he  saw  her  suddenly  turn  paler,  and  so  he  laid  her  back  on  the  pillow. 
In  ten  minutes  after  she  threw  up  a  quantity  of  liquid  florid  blood,  mixed  with 
clots.  She  did  the  same  an  hour  afterwards,  and  again  in  the  evening.  She 
continued  hiccuping.  lay  with  her  brows  knit,  but  in  no  pain.  The  pulse  rose 
to  136.  the  skin  grew  burning  hot,  the  tongue  coated  with  a  white  gelatinous 
fur.  The  voice  was  reduced  to  a  whisper.  In  this  state  of  hemorrhagic 


VOMIT:  -203 

-he  continued,  without  beconiiic_r  eomato-e.  till  she  died,  about  fifty-five 
hour-*  after  HIT  last  vmiiitiiiir  of  blood. 

••in.—  It  was  i'uii ml  that  au  ulcer  had  eaten  into  the  coronary 
artery  of  tin-  stomach. 

Tlio  svmpt»m<  in;r.  rly  as  severe  in  cases  which  do 

ultiinat-  e  fatal. 

\  \  V  I       V       _':•'-;-.  I  was  summoned  to  M:-   M    -.  ;.  :<-d  82, 
wliu  had  fallen  down  that  morniii<r  in  a  sort  of  fainting  fit.     On  recovering 

If,  she  threw  up.  as  was  alleged,  from  the  stomach  about  a  wine-. 
of  Idood.    The  ton-rue  was  dry.  and  in  the  centre  brownish.    The  epigastrium 
was  painful  on  pressure.     The  pulse  exhibited  the  largeness  and  loose  sharp 
stroke,  distiiK-tive  both  of  the  hardened  arteries  of  old  aire  and  also  of  hemor- 
rhage, both  which  factors  were  probably  united  in  this  patient. 

The  next  day  the  t,oiiirue  was  quite  dry  and  brown,  and  the  abdomen  more 
painful  on  pressure.     She  had  vomited  a  great  quantity  of  red  and  black 

•••d  ;f  number  of  Mack  stools. 

On  the  'Ji'iih  the  tongue  i:»t   nioister.     On  the  27th  she  again  fainted,  and 

her  face  became  anxious,  and  the  tonirue  dry  and  brown.     I  thought  she 

would  vomit  blond  a^ain.  but  no.  .-he  only  passed  it  in  a  black  stool.     On  the 

-ho  was  better  air.un.  and  with  one  more  relapse  on  the  '_".»th  she  finally 

•  T--d.  and  had  no  return  of  bloody  vomiting,  though  she  lived  several 

erwards. 

The  treatment  had  been  lemon  ice,  Bark,  Alum,  Opium,  and  Sulphuric 
Acid. 

•  must  have  ha<l  a  very  vigorous  constitution  to  have  sur- 
;  such  a  s<.-n<>u.s  illness  at  such  a  time  of  life. 

'•opes  of  age  the  following  0)  have  an  interest,  for 

I  think  it  i-  th«-  lest  patient  with  this  complaint  t 

hav.-  iia-1  uii'l'T  my  char 

•  <M.XX  VII.— Kli/.abeth  A— .  a-'-d   C.it.  wa-  admit  t.-.l    into  St.    Mary's 

J66.      Shi-  called  herself  a  strong,  healthy  woman,  ihouirh  sub- 

d   "  bilious  attack-."  and  ruptured  on  on.- -ide.      A  Her  feeling 

ht  in  the  belly  for  a  had  on  the  1 1th  vomited  a  small  quantity 

of  blood.      On   the   1-th   >\\>-  a^ai  i  vomit. -d.  and   this  time  nearly  a  i|iiart    of 

blood,  britrht-eolored.  and  with  dots  in   it.  but  not  frothy.     Tin-re  \va>  slitrht 

•  of  the  epiLfastriuin.  but  this,  she  said,  was  much  in 
at  the  time  of  the  ha-  -d  1'lack  blood  by  stool.     The 

normal. 

was  but  little  pulled  d^wii  by  her  attack.     So,  after  a  forti: 
in  the  hospital,  she  wc-ut  out. 


VOMITING. 

Vomiting  of  blood  may  occur  again  and  again  without  risking 
life. 

Sometimes  it  is  an  annual  affair,  as  in  CASE  CLYI,  and  again 
in  the  following. 

CASE  CLXXVI1I. — Henry  H —  came  under  my  care  at  St.  Mary's  in  Xo- 
vember,  1862,  having  in  October,  on  two  occasions,  in  going  home  from  his 
work,  thrown  up  what  seemed  to  him  near  a  pint  of  blood.  The  same  patient 
had,  in  October,  1861,  also  been  in  St.  Mary's  for  haematemesis.  It  is  right, 
however,  to  remark  that  he  had  emphysema  of  the  lungs  as  well ;  so  there 
might  perhaps  be  a  question  about  the  certainty  of  the  diagnosis  of  the  blood 
coming  from  the  stomach. 

In  the  following  cases  there  were  intervals  of  three  and  four 
years. 

CASE  CLXXTX.— In  the  middle  of  September?  1855,  Selina  Y— ,  a  widow 
of  48,  was  woke  up  at  two  in  the  morning  by  a  single  attack -of  profuse  hsemate- 
mesis.  She  was  my  patient  at  St.  Mary's  for  the  weakness  thence  arising,  but 
she  was  not  alarmed  at  the  occurrence,  as  she  had  been  ill  in  the  same  way 
three  years  previously. 

This  woman  experienced  again  another  gush  of  blood  in  October,  1859,  and 
was  under  my  care  at  St.  Mary's  afterwards.  Whilst  in  the  house  she  had 
waterbrash  one  morning,  and  ejected  a  cupful  of  clear  aqueous  fluid  with 
streaks  of  red  in  it.  She  reported  that  in  the  interval  of  the  two  admissions 
she  had  lost  no  blood. 

It  is  remarkable  that  in  this  case  there  was  no  tenderness  of  the  epigas- 
trium. 

CASE  CLXXX. — Catherine  C — .  a  servant,  aged  28,  was  admitted  to  St. 
Mary's  October  19th,  1858,  for  an  attack  of  hajmatemesis  which  had  just  oc- 
curred. She  described  herself  as  a  person  of  good  constitution  and  strong 
body,  but  she  acknowledged  to  having  had  a  similar  illness  three  years  pre- 
viously, which  had  reduced  her  more  than  the  present  one.  The  ejecta  had 
consisted  of  what  seemed  to  her  a  pint  of  blood,  at  about  4  P.  M.  on  three 
successive  afternoons,  with  very  slight  antecedent  symptoms. 

Again  a  longer  interval : — 

CASE  CLXXXI. — Elizabeth  F — ,  a  servant,  aged  23,  retched  up  a  tumbler- 
ful of  blood  a  few  days  before  her  admission  to  St.  Mary's,  May  30th.  1862. 
She  said  the  same  thing  happened  eight  years  before  to  a  greater  extent,  and 
that  ever  since  she  had,  besides  irregularity  of  the  catamenia  and  debility, 
suffered  from  time  to  time  with  sickness  after  meals,  but  had  not  seen  any  red 
in  it  till  the  present  occasion,  a  few  days  before  admission.  She  had  again 
several  attacks  of  vomiting  whilst  in  the  hospital,  but  threw  up  no  sanguine- 
ous fluid. 


VOMITIN'i.  205 

Ami  airain  a  longer: — 

\\.\II.      \:   tip    I'jinnincr  of  February,  1862,  I  was  reqn 
hy  Sir  Kanald  Martin  to  meet  in  consultation  on  the  case  of  a  gentleman  about 
f.o  years  of  aire.  who  was  gradually  dying  of  excessive  vomiting.     He  was  an 
olil  Indian,  and  he  described  ill  tuning  of  his  gastric  ailments,  least- 

:n'  first  thin^  which  drew  his  attention  to  the  stomach,  to  be  an  attack 
thirty  years  previously.  Twelve  years  after  that  he  had  an- 
other, and  two  or  three  at  shorter  intervals  which  I  forget.  But  during  the 
final  attack  of  vomiting,  of  which  he  died  in  the  course  of  the  spring,  he  lost 
no  blood,  the  cause  of  death  being  the  excessive  exhaustion  and  emaciation 
only.  It  was  diagnosed  all  along,  and  proved  by  autopsy  to  be  due  to  gastric 

It  would  probably  not  be  difficult  to  fill  up  all  the  inter- 
mediate years  with  instances,  but  those  quoted  are  enough  to 
<ho\v  that  blood  in  the  vomit  is  not  by  any  means  a  sign  of 
immediately  impending  danger.  It  really  would  seem,  unless 
bad  symptoms  detailed  in  the  two  consecutive  cases 
(( 'I, XX  V  and  CLXXVI)  should  be  present,  to  afford  in  itself  a 
good  omen  for  some  time  to  come. 

The  apnoarar.ce  of  the  blood  vomited  is  very  various. 

Mietimes  it  is  seen  in  streaks  among  the  mixed  matters 
ted.     See  case  of  Helena  F — ,  CASE  CLXXI,  &c. 
More  commonly  it  comes  in  a  //"-A.  as  in  James  P — ,  CASE 
[XIV ;  Solina  Y—  CASE  CLX  XIX. 

ictimes  it  has  remained  long  enough  in  the  stomach  to 
a/'//a/'  /e  masses,  and  then  it  is  somewhat  hard 

of  ejection. 

'.XXXIII.— Jani'-s  M — ,  aged  32,  a  potman,  was  attacked  at  the 
beginning  of  April.  1-r.o.  with  pain  of  a  continuous  character  in  the  pit  of 
-in  11  h.     Tli:-  continued  getting  worse  till  the  16th,  when  in  the  act  of 
TOmiting,  to  which  he  had  become  subject.  bebrOBghl  up  about  half  a  pint  of 
blood  black  in  color.      In  the  afternoon  of  the  next  day  he  brought  up  as  much 
:.ts  of  thick  black  blood  in  masses  so  tmiirli  a<  nearly  to  choke  him. 
The  tongue,  however,  remained   dean  and   uioi-t.  and  the  pulse  was  only  74  ; 
the  heart  and  lungs  were  healthy,  and  he  had  lost  the  pain  in  the  epigastrium 
even  when  it  \v.  '.  which  things  considered,  it   was  not  thought 

rii_'ht  to  detain   him   aiiove   fourda\s  in  I  ,'ly  as  he  wanted  no 

medi 

Sometimes  the  saii^uinr,  ion  has  remain. -d  I.HILT  enough 

•nly  to  ; 


206  VOMITING. 

cooked,  by  the  gastric  acid ;  and  then  it  assumes  the  reddish- 
brown  color  that  it  does  in  black  puddings  or  German  sausages 
from  a  similar  partial  cookery.  It  is  more  like  that  than  coffee- 
grounds. 

CASE  CLXXXIV. — Henry  C — ,  aged  50,  was  admitted  under  Dr.  Nairne 
into  St.  George's  Hospital  in  March,  1842,  and  died  in  about  a  month  with  an 
enormous  cancerous  mass  in  the  liver ;  part  of  this  had  ulcerated  the  wall  of 
the  stomach  by  pressure,  leaving  some  bloodvessels  with  open  mouths,  \vhirh 
must  have  continually  been  pouring  out  their  contents.  There  was  no  cancer 
of  the  stomach  itself.  The  vomit  during  life  consisted  of  "  coffee-grounds"  (as 
technically  called),  with  only  an  occasional  admixture  of  red  blood. 

From  this  instance  it  is  evident  that  "  coffee-ground"  vomit 
is  not  exuded  in  the  state  in  which  it  is  seen  (for  here,  of  course, 
it  must  have  exuded  red),  but  has  remained  for  a  certain  period, 
I  cannot  say  how  long,  in  the  cavity.  The  brown  stains  found 
in  the  walls  of  mucous  canals  after  death  are  in  fact  ecchymoses, 
which  have  probably  existed  a  long  time. 

Sometimes  the  color  is  still  more  changed — it  turns  green. 

CASE  CLXXXV. — John  N — ,  aged  35,  a  painter,  admitted  to  St.  Mary's 
Hospital  April  10th,  1858.  He  had  constant  pain  at  the  cardiac  end  of  the 
stomach  (increased  by  pressure),  waterbrash,  and  frequent  inability  to  keep 
down  his  food.  On  the  loth  he  vomited  half  a  pint  of  grass-green  matter, 
was  intensely  acid  to  test  paper,  complaining  at  the  same  time  of  pain  between 
the  shoulders  and  of  acid  rising  in  the  mouth.  On  the  16th,  before  breakfast, 
he  vomited  some  of  the  brown  matter  usually  described  as  coffee-grounds, 
after  which  the  acid  rising  in  the  throat  was  alleviated  for  a  few  days.  On 
the  28th  it  was  found  that  there  was  blood  in  the  vomit ;  but  he  does  not  seem 
to  have  had  any  gushes  of  it.  On  May  8th  he  is  reported  as  having  vomited 
the  green  fluid  and  blood  also.  I  have  no  further  notes  of  the  alterations  in 
appearance  of  his  vomiting;  but  it  was  relieved  by  leeches,  and  he  was  made 
an  out-patient. 

One  cannot  doubt  that  the  various  colors  visible  in  the 
vomit  were  due  to  one  and  the  same  cause,  namely,  blood.  The 
great  acidity  of  the  fluid  forbade  the  idea  that  it  consisted  of  bile, 
or  even  that  there  was  bile  enough  to  cover  it. 

Another  mode  in  which  hemorrhage  of  the  stomach  manifests 
itself,  and  by  no  means  an  uncommon  mode,  is  by  the  stools 
being  stained  black  or  blackish-red. 

CASE  CLXXX VI.— Esther  R— ,  aged  34,  admitted  to  St.  Mary's  October 
14th,  1853.  She  had  been  in  St.  George's  Hospital  six  years  before  for  hae- 
matemesis,  but  what  she  complained  of  on  admission  was  the  passage  of  blood 


I  TINT,.  207 

fur  tin1  last  two  months  by  the  bowels;  and  truly  cnoutrh  we  found  the  stools 

•in--  with  inky  matter  intimately  mixed  up  with  them.  sometimes  exhibit- 

<if  red  blood.     She  wns  much  weakened  and  blanched  by  the 

>  its  apparently  most  probable  source,  I 

i  tin-  patient  first  with  pur-rat  ivt-  cnemata.  and  then  with  ti-n-biiithinate 

and  astrinsrcnt  (Iron  Alum)  cnemata,  and  -rave  her  also  Decoction  of  I5a>  •!, 

which  i-  >aid  tu  act  most  on  the  lower  ln.wel.     Nothinjr  stopped  it  till  she 

tnuk  n\.xx  df  Sulphuric  Acid  with  rr^  iij  of  IJattley's  Liquor  Scdativus  three 

A    fi-w  days  alter  commencing  this  she  had  a  natural  fecal 

ition.  and  then  improved  rapidly  under  the  use  of  Quinine. 

It  is  dear  that  the  lust-used  course  of  treatment  must  have 

;  upon  the  stomach  principally,  for  it  certainly  does  not  stop 

iiiLf    from    the  colon.     And  from  the  stomach  came  the 

hemorrhage  on  a  former  occasion;  so  that  I  presume  it  di<l  .-u 

on  this  also. 

Why  had  she  bloody  vomiting  in  one  illness,  and  bloody  stools 
only  in  the  other?     One  may  lawfully  conjecture  that  the  I 
which  was  the  fountain  of  the  hemorrhage  has  extended  gradu- 
ally nearer  to  the  pyloric  orifice,  and  was  at  last  so  near  that  the 
sphincter  did  not  block  the  passage  through  —  that  is  to  say,  it 

•11  the  pylorus  itself. 

Tlii  by  the  ordinary  course  of  the  alimentary  canal 

rous  course  for  the  hemorrhage  to  take;   lor 
.  •raordinury,  even  unwarrantable  alarm,  as 
is,  it  is  liable  to  evade  notice  till  the  p; 

drains  to  death.     It  was   nearly  doing  so  in  the   case  quoted. 
un  in  the  next  <•. 


\\.\VII.  —  Sarah   G  —  ,  a^ed  'M.  a  housemaid,  always  ci. 
jr  .....  1   health   till  the  middl>-  of  .Inn--.  L857,  when   .-die  was  laid   up  with  sore 
threat   at   fii-t.      'l'\\i-   pa^.-cd   in!<>  a  w.-ai  iiiLr  l>ain  at  the  epigastrium.  . 
vated  l>y  f.Kid.  and  accmiipanied  by  si-vi-ral  attacks  of  voinitin.ir.  (hiring  which 
sin-   threw  Qp  blood.      >ln-   liecame   an    out-patient   at    St.    .Mary'.-    under   I'r. 
Markham'-  ml    lie    tindiii.ir   her  weakness   and    palene.-s    in 

alarminir  rapidity.  :u.  the  tuiiiiui-  dry  and  furred  as  in   licni.n  rha-ic 

iniiieiided  her  liein-r   admitted  on  Aiiuru.-t    'J'Jd.      \\  e  then  found,  as 
I  IT.  Mark  ham  had  susjiected.  but  the  patient  constantly  denied,  that  she  ] 
blood  ly  the  bowels  whenever  they  were  opened.      This    required    to   be   done 
by  artificial  means,  for  si.'  .'.  e.      On  •  • 

t.  lined  a  clot  of  librin.  wa.-hi-d  OOlorl  \%   as  an  eirg.     After  observing 

and  examining  her  for  a  !•  her 

H.  —  Pliimbi  A  •   ij. 

Opii  ^r.  j       In  pilula  ter  die. 
She  took   this  for  th.  md  then  iier  i  re  open  of  their  own 


208  VOMJ.TIXG. 

accord,  and  she  passed  a  dark  feculent  solid  stool  containing  no  blood.  The 
pills  were  therefore  left  off,  and  she  was  treated  with  occasional  doses  of 
Castor-oil  to  clear  the  bowels  of  the  remedy. 

But,  for  some  reason  or  another,  perhaps  a  relapse  of  the  hemorrhage,  I 
began  the  Acetate  of  Lead  again  on  September  16th.  giving  it  her  only  at 
night  however.  On  the  21st  she  passed  a  quantity  of  flocculent  fibrin  without 
blood.  On  the  23d  a  blue  border  was  observed  along  the  gums,  so  the  Lead 
was  again  left  off,  and  she  does  not  seem  to  have  lost  any  more  blood  during 
her  residence  in  the  hospital,  viz.  till  October  16th. 

This  is  the  worst  of  Acetate  of  Lead — you  are  so  likely  to 
have  the  chronic  poisoning  peculiar  to  the  metal  induced  by  it. 
It  seems  to  occur  in  direct  proportion  to  the  length  of  time  the 
salt  is  taken,  and  not  to  the  dose.  It  is  better  on  this  score  to 
give  a  very  few  large  doses,  even  to  run  the  risk  of  griping 
your  patient,  than  many  small  ones.  A  couple  of  doses  of  ten 
grains  each  will  likely  enough  be  sufficient.  I  have  so  adminis- 
tered it  in  haemoptysis  with  great  satisfaction. 

More  usually  the  bloody  vomiting  and  black  stools  occur  at 
the  same  time,  and  then  there  is  no  difficulty  in  discovering  the 
true  cause  of  the  latter.  The  following  is  the  most  familiar 
history : — 

CASE  CLXXXVIIL— Eliza  F— ,  aged  35,  was  admitted  to  St.  Mary's 
August  21st,  I860,  having  for  a  fortnight  suffered  from  vomiting  of  her 
food,  tasting  and  smelling  sour.  That  morning  she  had  begun  to  consider 
her  case  serious,  from  having  thrown  up  in  addition  some  clotted  blood  to 
the  extent  of  a  few  ounces.  There  was  pain  in  the  epigastrium,  running 
through  to  the  back,  and  increasing  by  very  slight  pressure. 

She  was  ordered  a  Blue  pill  and  Castor-oil,  and  then  twenty  minims  each  of 
Sulphuric  Acid  aud  Oil  of  Turpentine  in  a  mixture  three  times  a  day;  also 
ice,  milk,  and  cold  beef-tea,  like  all  other  patients  with  haematemesis :  but  the 
next  day  the  treatment  was  discontinued,  as  the  vomiting  had  ceased. 

There  was  no  more  blood  thrown  up  till  the  23d ;  the  medicines  were  re- 
sumed, and  it  ceased.  But  all  along  she  was  passing  black  stools,  as  of 
digested  blood. 

Then  her  bowels  became  costive,  and  she  took  only  some  Decoction  of  Cin- 
chona, and  was  discharged  on  September  7th. 

(These  two  last  cases  have  been  related  before,  as  instances  of  "  wearing 
pain.") 

To  find  the  remains  of  blood  in  the  stools  is  very  satisfactory 
in  hospital  practice,  in  order  to  confirm  the  statements  of  the 
patients,  which  are  not  always  to  be  trusted.  They  \\ill  talk 


VOMITI  209 

about  throwing  up  blood  to  excite  attention,  when  in  reality  it 
ily  simple  vomiting. 

Besides  designed  imposition,  we  have  also  to  guard  against 

ii stake  of  confounding  blood  coming  from  another  source 

with  that  from  the  stomach.     Thi  v  enough  to  run  into. 

xample  of  the  doubt  has  been  given  in  CASE  CLXXVIII. 

Water!  >]•;,.-!!  is  sometimes  found  along  with  vomiting  of  blood. 
It  is  remarked  in  CASE  CLXXIX,  Selina  Y — ,  and  also  in 

..  VI,  Sarah  S— . 
It  was  observed  again  in  the  following. 

X  X  X  I  X. — Mary  S — ,  a  cook,  aged  23.  was  admitted  to  St.  Mary '3 
July  27th,  18.">3.  She  stated  that  her  health  had  always  been  excellent  till 
six  months  previously,  when  she  began  to  experience  pain  in  the  chest,  and 
frequently  to  vomit  after  her  meals.  She  brought  np  her  food  mixed  with  a 
yellow  (?  saniruineous)  fluid.  She  was  under  medical  treatment  and  got  cured. 
Hut  six  weeks  before  admission  the  pain  returned.  Frequently  instead  of 
vomiting  she  used  to  eject  a  quantity  of  clear  watery  fluid  (waterbrash).  But 
what  brought  her  to  the  hospital  as  an  in-patient,  was  her  having  three  times 
lately  thrown  up  blood  by  vomiting.  Previous  to  the  hxmatemesis  there  had 
been  felt  darting  pains  in  the  epigastrium.  Rest  for  ten  days  in  the  hospital, 
and  half-a-dozen  leeches  to  the  epigastrium,  put  a  stop  to  all  her  symptoms, 
and  at  her  own  desire  she  returned  to  her  situation ;  so  there  was  evidently 
no  sham  in  the  > 

1  -aspect  in  these  cases,  where  waterbrash  is  joined  to  bloody 
vomiting,  that  the  lesion  which  occasions  the  latter  is  near  the 
cardiac  orifice.  You  do  not  have  here  the  pains  in  the  right 
shoulder  which  point  to  pylorio  lesions. 

I  have  spoken  without  hesitation  of  haBmatemesis  as  arising 
from  some  lesion  of  the  mucous  membrane,  by  which  a  more  or 

:. umber  of  larger  or  smaller  bloodvessels  have  been  broken. 

liae  mode  in  whii-h  the  rupture  is  effected  is  not  easy  to 

rtain.     Hut  it  dor-  j> lire  any  very  great  violence.    A 

blow  on  the  epigastrium  not  hard  enough  to  bruise  the  outside 
skin  may,  ior  example,  cause  it;  as  in  the  following. 

•Misan  L — ,  a-.  d  l.'i.  ill'-  tli--![>.ited  drunken  wife  of  a  laboring 

man.  had  a  tijrht  with  her  husband,  and  L'<>t  her  eye  blacked,  her  bark  kieked, 

ayd  a  punch  on  the  lielly.     The  two  form  not   the  latter. 

She  was  brought  to  the  hospital  April  3d,  lti.~»G.  because  on  going  uut  into  the 

U 


210  VOMITING. 

Edgware  Road  the  day  after  the  fight  she  felt  very  faint,  and  threw  up  a  good 
deal  of  blood.  It  was  at  first  considered  to  have  come  from  the  thoracic  vis- 
cera, seeing  that  she  had  no  bruises  or  pain  on  pressure  in  the  abdomen.  But 
examination  with  test-paper,  and  what  she  had  thrown  up  on  her  clothes, 
showed  it  to  be  acid,  and  to  have  come  from  the  stomach  therefore.  The 
pulse  was  hardly  to  be  felt ;  she  was  delirious,  the  skin  clammy,  and  the  feet 
cold ;  so  that  we  had  to  rouse  up  her  ebbing  life  with  hot  water  and  mustard. 
•  She  had  also  rr^xx  of  Oil  of  Turpentine  every  hour ;  but  as  at  night  she 
still  continued  vomiting  blood,  a  slab  of  ice  was  laid  on  the  epigastrium,  and 
Alum  and  Tannic  Acid  administered  by  the  mouth. 

Next  day  the  bleeding  had  ceased,  the  pulse  became  more  perceptible,  and 
the  mind  clear. 

There  was  no  return  of  the  symptoms,  but  I  kept  her  in  till  the  21st  for 
safety. 

In  the  last  history  it  was  mentioned  that  there  being  no  pain 
in  the  epigastrium  made  the  diagnosis  doubtful  at  first  blush, 
though  the  injury  was  proved  so  indubitably  to  be  in  the  stomach 
by  after  events  and  observations.  In  the  case  of  Selina  Y — 
(CASE  CLXXIX)  there  was  also  no  pain  in  the  epigastrium. 
Perhaps  a  clue  to  the  condition  existing  under  such  circum- 
stances may  be  afforded  by  the  following. 

CASE  CXCI. — Elizabeth  A — ,  a  cook,  aged  35,  but  unmarried,  was  admitted 
to  hospital  under  me  June  10th,  1861.  She  had  the  appearance  of  good  health, 
and  said  she  had  always  enjoyed  it  till  five  days  previously,  when  she  felt  so 
nauseated  and  giddy  that  she  thought  a  bilious  attack  must  be  impending.  A 
disagreeable  rising  in  the  throat  lasted  all  day,  and  at  10  P.  M.  she  vomited 
violently  and  threw  up  blood.  There  was  perhaps  also  bile  mixed  with  it,  as 
she  said  it  tasted  bitter.  This  was  on  Wednesday,  and  on  Friday  she  again 
vomited  blood  and  passed  black  motions,  and  on  the  Monday  came  to  St. 
Mary's.  In  the  mean  time  she  had  been  taking  pills  bought  at  a  small  chem- 
ist's shop,  and  therefore  probably  containing  Mercury,  the  usual  panacea  in 
counter  practice.  At  all  events,  she  was  salivated  on  admission. 

In  this  case  there  was  no  pain  in  the  epigastrium  without  or  with  pressure. 
The  liver  on  admission  was  found  much  enlarged  laterally  and  vertically,  yet 
neither  was  it  painful  on  pressure.  She  had  no  medicine. 

On  the  12th  the  liver  was  much  smaller.  The  black  color  had  disappeared 
from  the  motions,  and  she  had  no  more  vomiting  of  blood,  and  went  out  on 
the  28th. 

. 

I  suppose  the  cause  of  hgematemesis  here  was  congestion  of 
the  liver — a  condition  which  is  said  often  to  occur  in  practice, 
though  I  confess  I  can  seldom  make  it  out  by  percussion. 


VOMITING.  211 

From  the  above  >    MB  1    •  ''ild  conclude  that  the  vomiting  of 
i  deiiot.-s.  if  not  perhaps  an  open  bloodvessel,  yet  such  u 
;  pathological  state  of  the  mucous  membrane  as  requires  a 
completely  alterative  renewal,  and  that  such  alterative  renewal 
-t  brought  about  by  general  analeptic  remedies,  by  the 
;oval  of  congestion,  and  by  the  restoration  of  capillary 
circulation  through  local  depletion.     I  should  infer  also  that 
-ters  of  the  immediate  hemorrhage  are  Turpen- 
tine and  Aeetate  of  Lead  internally,  and  ice  externally. 

SECTI.ON  V. 

Acid  fermentation  of  vomit. 

The  contents  of  a  healthy  stomach  ejected  by  any  accidental 
cau.-e  have  a  certain  amount  of  acid  reaction  from  the  presence 
of  the  acid  gastric  juice,  and  indeed  this  is  necessary  to  their 
solution.  And  a  degree  of  sourness  in  the  viands  consumed 
seems  to  favor  their  digestion.  So  that  acidity  in  itself  is  not 
a  morbid  phenomenon  in  vomit. 

•  it  be  understood,  then,  that  I  do  not  refer  in  this  section 

to  the  ordinary  normal  acidity  of  the  gastric  contents,  but  to  the 

ntation,  principally  into  acetic  acid,  of  the  whole  mass,  to 

ion  of  undigesting  food. 

1  -<>r  truly  in  some  cases  of  vomiting  the  excessive  acidity  of 
the  mass  is  a  very  marked  feature.  The  throat  is  burned  by  it, 
the  teeth  roughened  and  the  eyes  made  to  smart,  just  as  by 
talcing  into  the  mouth  a  strong  solution  of  acetic  acid.  And  the 
sour  smell  of  an  acid  volatile  at  a  low  temperature  is  dill' 
through  the  air.  In  fact,  the  whole  mass  of  the  ejecla  has 

me  acid,  in.-tead  <>f  m. -rely  having  acid  mixed  with  it. 
Tl.<  •ention   in  the  stomach   of  the  remains  of 

the  meal  so  long  that  they  have  had  lei.-nre  to  ferment  through- 
out,  instead   of  1.  they    beran  1   by   the 

1C  jui.-e.       |  of  the  retention  mo.-: 

coating  of  the   liriinir   membrane   with  adhe-ive   mucus,  which 
impedes  the  peristalt;  -  and  pr6V6Hta  the  ^a.-trie  sol- 

vents  from    pen.-tratin-'    tli.-  ma-s.      The  acidity  does   not  Q 
indigestion,  but  tin-  i1  I        the  acidity. 

lining  t.  ng  that  any  internal  decom- 


212  VOMITIXG. 

position  to  which  it  may  be  from  its  nature  apt  is  aided  by 
time,  the  mucus  also  in  itself  is  an  encouragement  to  chemical 
action.  A  familiar  instance  of  this  is  the  rapid  decay  of  the 
urine  in  a  catarrhal  bladder.  The  mucus  is  probably  itself  in  a 
state  of  chemical  change  which  is  thus  propagated  to  the  mass. 

The  decomposition  of  the  mucus  is  shown  by  the  frequency 
with  which  different  sorts  of  low  parasitic  growths,  or  moulds, 
are  developed  in  it.  The  well-defined  species  Sarcina  Ventriculi 
is  the  most  distinctly  marked  of  these,  which,  though  detected 
occasionally  elsewhere,  certainly  finds  its  most  congenial  home 
in  the  stomach.  In  other  places  it  has  been  found  in  completely 
dead  matter  (as  by  Virchow  in  gangrenous  lung)  or  else  a  float- 
ing wanderer  in  excreted  fluids,1  but  on  the  lining  membrane 
of  the  stomach  it  may  be  seen  fixed  and  growing  in  the  mucus. 
It  is  not  often  that  an  opportunity  occurs  of  proving  to  the  eye 
that  such  is  the  habitat  of  the  Sarcina — we  frequently  find  it 
vomited,  but  the  patients  seldom  die  during  their  illness,  the 
complaint  not  being  a  fatal  one.  One  indeed  has  offered  itself 
to  me  in  CASE  CXXXIX,  a  girl  of  fourteen,  who  died  in  St. 
Mary's  Hospital  of  enlarged  heart.2  She  had  frequent  attacks 
of  sour,  but  not  frothy  vomiting,  before  death,  and  at  the  au- 
topsy we  found  the  great  curvature  of  the  stomach  thickly  clothed 
with  a  stringy  mucus,  very  difficult  to  detach,  in  the  outer  layer 
of  which  a  considerable  quantity  of  Carcinae  were  imbedded. 

It  is  pretty  clear  from  this  that  the  mucus,  and  not  the 
stomach's  contents,  is  the  root-soil  of  the  Sarcina. 

Being  fixed  then  in  a  permanent  home,  and  rapidly  replacing 
with  new  growths  those  which  are  wiped  away  by  the  food,  the 
Sarcina  is  probably  not  inert.  A  great  number,  perhaps  all, 
of  those  cryptogamous  plants  whose  nature  is  to  grow  upon 
decomposing  organic  matter,  have  the  property  of  promoting 
decomposition,  so  that  they  are  not  only  consequences,  but 
causes  also,  of  decay.  It  is  found,  for  example,  that  the  gutta- 
percha  covering  to  electric-telegraph  wires,  when  laid  down 
near  the  roots  of  oaks,  becomes  rapidly  rotten  from  the  presence 
of  a  fungus  peculiar  to  that  tree.  Put  your  jam  in  a  new  cup- 

1  Parkes,  "  On  the  Urine,"  p.  213. 

2  See  page  171. 


VOMITING.  213 

l>o;ird,  and  it  will  keep  much  longer  than  in  one  where  mould 
Las  previously  grown.  Saving  housewives  used  formerly  to 

what  they  called  a  "vinegar-plant;"  it  is  a  simple-celled 
cryptogam  found  in  old  If  placed  in  sugar  and  water, 

it  makes  the  whole  undergo  the  acetous  fermentation  in  two  or 
thive  weeks,  instead  of  the  process  occupying  several  months. 
The  mould  found  in  yeast  (the  Torula  Cerevisiae),  though  not 

;ial  to  alcoholic  fermentation,  certainly  augments  the 
rapidity  of  its  induction ;  so  that  it  is  entirely  in  accordance 
Avilh  known  physical  laws  if  the  presence  of  sarcinas,  or  of  the 

plant,  on  the  mucus  of  the  stomach  should  bring  on  fer- 
mentation in  the  food  before  the  obstructed  absorbents  have 
time  to  take  it  up.  Both  have  been  found  in  the  contents  of 
the  stomach  ejected;  and  it  is  shown  by  the  case  I  quoted,  that 
sarcinae  at  least  may  exist  adherent  to  the  mucus  without  being 
thrown  up,  at  least  in  quantities  sufficient  to  be  discovered. 
Probably  oftencr  than  we  fancy  these  moulds  are  unseen  pro- 
moters of  the  rapid  fermentation  which  takes  place  so  mys- 
teriously in  the  stomach  of  invalids. 

The  chief  factors  in  this  fermentation,  then,  I  take  to  be 

mucus  adherent  to  the  walls  of  the  stomach.    With  this  mucus 

there  gets  intimately  mixed  up  some  dead  animal  matter  which 

Mnl  moulds  and  so  encourages  the  fermentation. 

lead  animal  matter  often  is  blood  exuding  from  the  gastric 
:  for  the  mucus  is  so  tough  that  the  food  taken  into  the 
•inch  has  much  difficulty  in  blending  with  it. 
The  following  cases  are  typically  illustrative. 

<'X<  '11.— rornelius  K — ,  a  laborer,  was  admitted  to  St.  Mary's  June 
27th.  lH"t<i.  For  tin-  last  ten  years  he  had  been  in  the  habit  of  occasionally 
vomitinir  blood,  on  the  average  about  three  times  a  year.  Of  late  he  had 
vomited  more  frequently,  but  there  was  not  always  blood  in  what  he  threw 
up.  Sometimes  the  vomit  was  very  fluid  ami  sour,  sometimes  it  contained 
yellow  matter,  and  when  blood  was  thrown  up  it  was  dark  and  clotted.  He 
li.id  constant  pain  in  the  epigastrium,  but  that  was  much  auirravated  by 
pressure,  and  also  before  and  after  ejection.  His  most  usual  time  for  vomit- 
ing was  about  four  in  the  moruini:  ;  if  it  recurred  aL-ain  in  the  tweir 
hours,  it  was  usually  in  the  evening.  He  was  much  emaciated  by  his  illness. 
The  tongue  was  very  clean. 

After  admission  the  vomitinir  was  found  to  occur  with  regular  periodicity 
morninir  and  evening.  The  Batter  thrown  up  was  copious.  In-own,  and  frothy. 
It  diffused  a  strong  Hm-ll  of  acetic  acid.  Often,  when  left  to  stand,  it  went 


214  VOMITING. 

on  bubbling  and  frothing1,  so  as  to  flow  over  the  edge  of  a  small  vessel.  Once 
only  were  Sarcince  detected  in  it. 

He  was  treated  for  a  week  with  a  drachm  of  Hyposulphite  of  Soda  three 
times  a  day,  but  it  did  not  seem  to  check  the  symptoms  at  all.  He  then  h:id 
eight  grains  of  Quinine  with  twenty  drops  of  Laudanum  every  night,  and  for 
nearly  a  fortnight  he  did  not  throw  up.  However  the  trouble  then  returned, 
though  not  so  periodically.  He  complained  of  loss  of  appetite  and  pain  after 
swallowing  fluids.  He  then  had  ten  drops  of  Oil  of  Turpentine  three  times 
a  day  without  benefit,  and  with  some  increase  of  pain  at  the  epigastrium. 
Then  be  had  six  Leeches  on  the  epigastrium.  After  this  the  vomit,  though 
intensely  acid,  seems  to  have  contained  no  more  of  the  brown  frothy  matter. 
He  left  the  hospital  August  4th,  having  gained  so  much  flesh  that  he  thought 
himself  able  to  work. 

CASE  CXCIII. — Eliza  T — ,  aged  35,  a  married  woman,  was  admitted  to  St. 
Mary's  January  14th,  1853.  She  had  a  child  nine  weeks  old,  and  during  her 
pregnancy  she  related  that  she  had  suffered  much  from  sickness.  She  also 
frequently  had  a  pain  come  between  the  shoulders,  which  extended  round  to 
the  abdomen,  and  lasted  about  four  hours.  Since  her  lying-in  the  sickness 
had  continued,  and  on  admission  she  had  pain  at  the  epigastrium  on  pressure. 

After  admission  we  found  that  she  had  constant  uneasiness  following  her 
meals,  and  that  she  was  never  at  ease  till  either  the  food  returned  spon- 
taneously, or  she  ejected  it  by  exciting  vomiting.  On  examination  of  the 
matters  vomited  spontaneously,  they  were  found  frothy,  and  containing  a  con- 
siderable quantity  of  Sarcina  Ventriculi  in  each  specimen. 

She  was  treated  at  first  with  Leeches  to  the  pit  of  the  stomach  and  Hydro- 
cyanic Acid  internally.  She  got  better  at  first,  but  then  relapsed ;  when  she 
was  put  upon  two  drachms  of  Hyposulphite  of  Soda  thrice  a  day.  She  had 
no  more  vomiting  at  all  after  this,  and- went  out  in  eleven  days  in  good  health. 

CASE  CXCIV.— Alfred  F— ,  aged  25,  died  August  9th,  1859.  At  the  post- 
mortem examination  there  was  found  an  ulcer  the  size  of  a  crown  piece  in  the 
duodenum,  about  an  inch  below  the  mouth  of  the  gall-duct.  The  ulcer  had 
penetrated  the  coats,  but  the  gut  was  at  this  point  adherent  to  the  pancreas, 
which  had  prevented  perforation.  All  the  intestines  were  filled  with  partially 
digested  blood,  and  this  hemorrhage  seemed  to  have  been  the  cause  of  death, 
for  the  lungs  and  liver  were  completely  blanched  with  bloodlessness.  He  had 
died  fainting  from  loss  of  blood  by  the  bowels. 

This  man  had  previous  to  death  been  my  patient  at  St.  Mary's,  with  jaun- 
dice and  vomiting  of  brown,  sour,  fermenting  matter,  in  which,  however,  no 
Sarcince  were  found.  The  tongue  had  been  throughout  his  illness  remarka- 
bly clean. 

CASE  CXCV.— Mr.  Edmund  L— ,  aged  27,  December  19th,  1861,  for  the 
last  six  months  has  been  in  the  habit  of  throwing  up  an  hour  after  many  of 
his  meals,  especially  dinner,  a  quantity  of  sour-scented  matter,  "frothing  like 
yeast,"  according  to  his  description.  He  has  no  constant  pain  at  the  epigas- 
trium, and  very  little  on  pressure.  His  previous  illnesses  have  been  an  attack 
similar  to  this  seven  years  ago,  and  a  sharp  pain,  like  pleurisy,  last  year. 


VOMIT1  215 

I  prescribed  for  him — 

R. — Soda-  IIyi>i.snlj>liiti>  p)j. 

Acidi  Hydrocyanic!  tliluti  n\,v, 

;I-;L-  ('amphorae  fl3J.    Ter  die. 

try. 

1'  -A  mutton  chop;  stale  bread  ;  water. 

i's.— Milk,  with  one-quarter  of  its  bulk  of  lime-water;  stale 
brr;ul  or  captain's  liisciiit. 

II'  vomited  just  after  leavinir  my  room,  but  only  once  again  after  commenc- 
ing tlie  use  of  tlic  medicine-.     After  a  week  he  was  troubled  with  some  intes- 
tinal flatulence,  which  was  entirely  obviated  by  fifteen  grains  of  Charcoal 
every  iiLrht  and  smut'  I'epsine  at  dinner.     He  had  also  some  Strychnine  as  a 
.  al  remedy  for  his  indigestion. 

SECTION   VI. 
Fecal  vomiting. 

To  quote  instances  and  discuss  this  subject  in  detail  would  be 
to  travel  out  of  the  province  of  "The  Indigestions"  too  far; 
formal  notice  of  it  can  scarcely  be  omitted  from  an  enu- 
meration of  the  morbid  matters  ejected  in  vomiting. 

Feces,  or  more  strictly  speaking  matters  having  a  feculent 

smell,  are  found  in  vomit  only  where  a  mechanical  impediment 

has  completely  arrested  the  onward  movement  of  the  peristaltic 

in  a  lower  part  of  the  intestinal  canal.     It  lasts  as  long  as 

the  impediment  lasts,  and  ceases  with  its  ceasing.     The  cure 

-olely  in  the  direct  removal  of  the  cause. 

il   vomiting  is  popularly  ascribed  to  a  reversal  of  the 
-taltic  motion;  but  I  do  not  think  it  desirable  to  resort  to 
such  a  strained  explanation.    When  we  reflect  that  about  twelve 
quarts  of  secretion,  bile,  and    intestinal  juices  together,  not 
counting  food,  are  daily  poured  into  the  intestines,1  it   is 
to  see  that  the  onward  wave  and  absorption  have  only  to  be 
for  the  ilia  to  be  overfilled,  and  for  their  contents  to 
overflow  upwards  into  the  stomach.     Then-  they  naturally  pro- 
duce vomiting,  just  as  they  would  if  swallowed.     No  reversal  is 
oeoasaarj. 

N  -  -     h  an  arr>  place  most  notably  and  obviously  in 

strangulated  hernia,  in  which  without  any  inflammatory  action 

1  Bidder  and  Schuii.lt. 


216  VOMITING. 

having  arisen  we  have  vomiting,  which  does  not  endure  long 
without  becoming  feculent.  And  a  like  paralysis  falls  upon 
the  muscles  and  absorbents  of  the  bowels  in  peritonitis,  also 
inducing  vomiting. 

It  is  true  that  this  vomiting  in  either  case,  though  it  tends  to 
become  feculent,  does  not  always  arrive  at  the  point  of  being 
so.  There  may  be  too  little  feces  already  prepared  in  the  canal 
to  odorize  the  great  mass  of  liquid ;  or  the  arrest  of  movement 
may  take  place  too  high  in  the  ilia ;  or  it  may  be  just  complete 
enough  to  fill  the  ilia  while  yet  some  feces  drain  off'  at  the 
lower  end.  These  circumstances  do  not  alter  the  essential  nature 
of  the  act. 

I  think  the  smell  is  derived  from  the  contents  of  the  lower 
ilia.  I  doubt  much  if  liquids  can  overcome  the  ilio-c?ecal  valve, 
even  when  paralytic.  It  is  a  valve,  not  a  sphincter,  and  offers 
a  resistance  even  in  the  dead  body. 

SECTION  VII. 
Vomiting  of  unchanged  food,  and  hysterical  vomiting. 

By  far  the  most  common  cases  of  vomiting  are  those  in  which 
the  ejecta  consist  of  food  scarcely  if  at  all  changed  from  the  state 
in  which  it  is  swallowed.  Sometimes  it  is  moderately  acid  from 
the  admixture  of  a  small  quantity  of  gastric  juice ;  sometimes  it 
is  neutral. 

It  is  not  my  intention  here  to  discuss  accidental  or  occasional 
vomiting  from  external  causes,  which  may  be  considered  rather 
the  business  of  the  physiologist,  but  such  as  having  a  deleterious 
influence  on  the  general  health  comes  under  the  care  of  the 
physician. 

This  sort  of  vomiting  happens  soon  after  food  has  been  taken, 
and  is  always  preceded  by  a  feeling  of  discomfort  at  the  epigas- 
trium, often  by  nausea ;  indeed,  it  seems  often  to  be  a  sort  of 
semi-voluntary  movement  to  relieve  that  discomfort. 

I  do  not  know  but  what  in  all  vomiting  there  is  something  of 
an  exertion  of  the  volition ;  but  in  some  cases  there  is  a  much 
more  marked  feature,  and  the  voluntary  character  may  be  made 
use  of  in  the  treatment.  It  is  an  important  point  to  observe, 


VOMITIM,.  217 

and  I  shall  therefore  cite  first  some  typical  examples  of  its  being 
under  the  control  of  the  will. 

1 VI.— Mi.-s  Kllon  H— ,  aged  14  or  15,  was  under  my  care  in  the 
spring  iif  1  -'>:'-.  for  treneral  ill-health  and  emaciation.  There  were  some  jrhm- 
dular  swellings  in  the  abdomen  and  groin,  but  hardly  enough  to  account  for 

\treine  decree  of  emaciation,  dry  skin,  and  depression  of  spirits.  On 
further  inquiry  it  appeared  that  for  four  years  she  had  experienced  discom- 
fort around  the  waist  after  eatinir.  and  had  been  in  the  habit  of  going  away 

•ly  soon  after  meals  and  vomiting  up  what  she  had  taken.  She  said  she 
could  not  help  it.  but  yet  it  appeared  that  when  circumstances  prevented  her 

aient.  she  was  able  to  restrain  herself  for  a  time.  Acting  on  this  hint, 
;  red  her  parents  to  exert  their  authority  and  forbid  the  ejection  of  food. 

e  her  (with  the  Iodine  ordered  for  the  glandular  swellings)  some  Cod- 
liver  Oil.  and  sent  her  to  be  amused  at  the  sea-side.  In  a  fortnight  I  heard 
from  her  father  that  she  had  become  convinced  of  the  importance  of  keeping 
off  vomiting,  but  that  still  from  habit  the  food  would  rise,  on  which  she  swal- 
lowed it  a<:ain.  according  to  her  own  very  appropriate  phrase  "chewing  the 
cud."  The  best  evidence  he  could  give  of  the  success  of  treatment  was,  that 
she  had  gained  in  weight  four  pounds  the  first  week  and  four  pounds  the 
second.  This  girl,  though  neither  hysterical  nor  insane,  was  yet  very  original 
in  her  notions,  and  had  apparently  out  of  her  own  head  devised  the  vomiting 
as  a  relief  to  epigastric  discomfort. 

The  vomiting  may  at  first  have  been  wholly  intentional,  but 
latterly  it  seemingly  assumed  a  more  involuntary  and  reflux 
character,  as  shown  by  the  rising  of  the  contents  of  the  stomach 
into  the  fauces  in  spite  of  the  efforts  of  the  patient  to  keep  them 
down. 

In  the  following  case  the  vomiting  was  at  first  involuntary, 
and  then  when  the  patient  got  better  and  was  really  able  to 
prevent  it,  she  designedly  induced  it  as  a  relief  to  her  discom- 
fort. 

r\r  VII.—  Emily  <J— .  n<r<>d  20.  maid-servnnt,  presented  herself  at 

St.  Mary's  September  L'lth.  ls>.  She  was  reported  subject  to  hysteric  fits, 
for  which  she  had  already  l>eeii  an  in-patient  in  ls.">7.  She  was  very  pale  and 
iihle^matic.  ami  the  cataiuenia  were  irreirular.  She  had  an  hysteric  fit 
on  the  25th.  On  the  2sth  she  complained  much  of  headache,  and  begun 
vomiting  after  all  food.  Tin-  next  morning  the  catameuia  appeared.  The 
vomitiuir  continued  very  obstinate,  in  spite  of  Valerian  in  decoction  and  tinc- 
ture, and  Uroinide  of  |'OT:I  —  ;MIU.  Showerliatlis  at  last  stopped  it.  and  then 
she  designedly  brought  it  back  by  putting  her  fingers  down  her  throat. 

In  the  1  -nenial  t  med  to  bring  on  the 

vmptums.     In  the  next  it  relieved  them. 


218  VOMITING. 

CASE  CXCYIIT. — Mary  H — ,  aged  16,  was  admitted  into  St.  Mary's  Decem. 
ber  16th,  1853.  She  was  complaining  of  flatulence  in  the  bowels,  eructations, 
and  vomiting  of  food.  She  had  been  wearing  a  large  wooden  busk  to  her 
stays.  The  catamenia  had  been  regular  since  the  age  of  fourteen,  except  the 
last  period,  which  was  overdue  ten  days.  She  continued  vomiting  everything 
she  tried  to  swallow  all  that  day,  the  next,  and  the  next  after  that.  On  the 
20th  she  vomited  part  of  her  breakfast,  and  then  the  catamenia  appeared,  and 
she  vomited  no  more,  though  kept  in  a  few  days  to  see  if  the  symptoms 
returned. 

The  frequent  connection  of  vomiting  in  the  female  sex  with 
that  same  state  of  constitution  which  induces  hysteria  and  also 
irregularity  of  the  catamenial  periods,  leads  one  to  employ 
Valerian  even  when  the  menses  are  regular;  and  it  is  often 
successful. 

CASE  CXCIX. — Mary  Ann  T — ,  aged  18,  was  an  in-patient  at  St.  Mary's 
December  3d,  1855,  for  an  attack  of  continuous  vomiting  of  all  food,  which 
had  lasted  six  weeks.  She  said  she  had  been  subject  to  attacks  of  this  sort 
since  her  childhood ;  but  they  had  not  prevented  her  arriving  at  puberty  at 
fourteen,  and  menstruating  regularly  ever  since,  having  a  good  appetite,  and 
growing  up  a  plump,  cherry-cheeked  girl.  She  was  given  simple  diet  with 
milk  and  lime-water,  with  a  mixture  of  Rhubarb  and  Gallic  Acid  three  times 
a  day. 

The  sickness  continued  as  bad  as  ever  on  the  5th,  the  bread  and  the  milk 
taken  being  rejected  exactly  as  swallowed.    Then  she  was  ordered 
R. — Infusi  Valerianse  fl^j, 

Tincturse  Valevianae  co.  fl^j.    Ter  die. 

An  immediate  good  effect  followed.  She  did  not  eject  the  medicine,  and 
the  next  day  she  was  able  to  retain  the  milk.  She  had  a  little  relapse  of 
sickness  on  the  10th,  but  after  that  continued  well,  and  left  on  the  20th. 

Functional  vomiting  is  sometimes  so  bad  that  no  remedies 
can  be  kept  on  the  stomach,  and  then  a  very  good  expedient  is 
to  give  that  organ  a  complete  rest. 

CASE  CC. — Esther  D — ,  a  stout  young  woman  of  21,  was  admitted  to  St. 
Mary's  August  23d,  1859.  She  had  been  ailing  for  a  fortnight  with  headache 
and  general  malaise,  and  pain  in  the  left  hypochondrium.  On  the  21st  she 
had  an  hysterical  fit,  and  afterwards  commenced  vomiting  very  violently.  She 
had  great  pain  across  the  pit  of  the  stomach,  and  the  vomiting  and  this  pain 
were  immediately  induced  by  an  attempt  to  swallow. 

She  lay  on  her  back,  with  the  knees  drawn  up  like  a  person  with  peritonitis. 
But,  very  unlike  a  person  with  peritonitis,  the  abdominal  muscles  were  vio- 
lently exerted  in  breathing.  Her  skin  was  hot  and  dry,  her  pulse  120,  her 
tongue  coated  with  a  yellowish  fur.  Altogether,  she  was  extremely  ill,  but  a 


•ITIXG,,  219 

good  di>al  of  her  febrile  s-  •  !  due  to  her  being  partially  under  the  in- 

flu<  nee  of  Mercury,  which  hail  heen  assiduously  given  up  to  her  admission. 
The  -.nuns  were  ulcerated,  and  blood  oozed  from  some  part  of  the  fauces 
staininir  the  vomit  with  streaks  of  blood. 

T«-n  I. ••.  ches  were  put  on  the  epigastrium,  but  they  did  not  seem  to  relieve 
the  pain. 

She  was  ordered  to  have  no  food  or  medicine  by  the  mouth,  but  half  a  pint 
of  heel-tea  in  an  enema,  with  five  drops  of  Laudanum  every  three  hour-. 

She  was  fed  in  this  way  for  ten  days,  when  some  warm  beef-tea  was  ; 
her ;  that  she  threw  up.  hut  was  able  to  retain  it  when  quite  cold.  After  this 
she  wax  alile  t<>  retain  her  food  for  a  week  or  so.  But  then  the  vomiting  re- 
turned, though  not  so  bad  as  before.  She  was  treated  with  Valerian,  with 
mine,  and  with  IMisters  ;  hut  the  success  of  each  remedy  was  very  tem- 
porary. On  Octoher  10th,  a  cold  shower-bath  was  ordered  to  be  taken  every 
morniu?,  and  an  immediate  stop  was  put  to  her  vomiting.  The  symptoms  did 
not  occur  at  all  again,  though  she  was  kept  in  till  the  28th  to  be  watched  and 
to  have  haths. 

Entire  rest  given  to  the  stomach  for  a  few  days  will  put  a 
st<>]>,  final  or  not  I  cannot  say,  to  vomiting  of  a  much  more 
chronic  character,  and  even  where  the  souring  of  the  mass 
seems  to  point  to  something  more  than  the  functional  nervous 
lysis  which  has  caused  it  in  the  hysterical  cases  already 
quoted. 

'  I.—  Charlotte  S — ,  a  dusky,  tongh-looking  spinster  of  28,  admitted 

M.i'-\  -  M  arch  LM'ith.  isfio.     Kiirhteen  months  previously  she  had  causrht 

cold,  and  after  three  days  was  taken  with  vomiting  very  soon  after  eatinir. 

Tin-  matters  vomited  are  the  food  she  has  been  taking,  often  accompanied  by 

-idmlile  quantity  of  fluid  tasting  sour.     This  has  made  her  weak  ami 

diminished  the  catamenia.  which  are  scanty,  though  regular, and  accompanied 

by  a  pood  deal  of  pain.     The  last  six  weeks  she  had  got  worse,  and  could  keep 

no  food  on  her  stomach  at  all. 

On  admission  her  pulse  was  96,  full  and  strong  enough,  the  tongue  was 
furred,  the  h-.wels  wrc  costive,  the  urine  was  sliirhtly  alkaline,  not  alhnminoiis. 

For  two  days  -lie  remained  in  hospital,  vomiting  all  her  food,  hut  taki 
medicine  :  for,  either  hy  areident  or  intention.  I  had  written  no  prescription. 
On  the  L'-tii  -lie  wax  ordered  to  have  no  food  by  the  mouth  at  all.  but  half  a 
pint  of  hcef-tca  with  live  drops  of  Laudanum  as  an  enema  every  three  hours. 
She  retched  no  more. 

On  the  151st   some  milk  and   Lim»-water,  in  small  quantities  at  a  time  was 
given   her  to  drink,  and  she  kept   it  down.     Still,  however,  the  mem., 
trusted  to  as  the  chief  nutriment. 

Vpril  4th  sh"  tried  a  muttou-c!j,.p.  and  succeeded  iu  retaining  it.     Ofl 
the  loth  .-he  left  well. 


220  VOMITIXG. 

It  was  observed  that  when  she  took  to  meat  again  the  urine  was  acid, 
deposited  urates,  and  contained  a  little  albumen. 

In  the  following  case  the  habit  was  still  more  ingrained  by 
time,  and  also  the  color  of  the  vomit  induced  a  suspicion  that 
there  was  hemorrhage  of  the  mucous  canal  in  some  part,  either 
oesophagus  or  stomach,  yet  it  was  cured  by  a  temporary  rest. 

CASE  CCII. — Mrs.  S — ,  a  small,  swarthy,  bright-eyed  woman  of  22,  was 
brought  under  my  care  March  9th,  1861,  for  constant  vomiting  of  three  years' 
duration,  which  she  attributed  to  having  caught  cold  during  a  monthly  period, 
having  her  courses  checked  for  several  months  at  nineteen  years  of  age,  when 
a  virgin.  Her  food  was  always  returned  by  the  mouth  within  ten  minutes 
after  swallowing,  and  was  unchanged  in  appearance.  Besides  this,  she  also 
vomited  at  other  times,  when  the  stomach  was  empty,  if  her  mind  was  excited. 
Indeed  she  did  so  in  my  own  room,  ejecting  some  reddish-brown  granular  and 
flocculent  matter,  which  looked  exceedingly  like  semi-digested  blood. 

She  was  not  much  emaciated  ;  her  catamenia  had  returned  ;  she  had  mar- 
ried six  mouths  before  I  saw  her,  and  had  a  miscarriage  at  an  early  term  of 
foetal  life — four  months  after  marriage.  All  which  proofs  of  vigor  seemed  to 
show  that  a  good  deal  of  nourishment  must  escape  the  rejection  by  vomiting. 
She  said  she  felt  constantly  hungry,  and  was  evidently  of  a  hysteric  tempera- 
ment. 

I  advised  that  she  should  be  kept  entirely  without  food  and  nourished  by 
enemata  of  beef-tea  and  Laudanum  for  a  week,  whilst  at  the  same  time  the 
stomach  was  further  quieted  by  the  application  of  a  few  Leeches  to  the  epi- 
gastrium, and  some  Bismuth. 

On  the  17th  I  heard  from  Dr.  Woodhouse,  of  Hertford,  who  had  undertaken 
to  watch  the  case,  that  they  had  not  arrived  at  continuing  the  treatment  a  full 
week,  but  that  for  two  days  the  patient  had  taken  food  and  kept  it  down.  He 
reported  well  again  on  the  18th.  But  on  the  20th  he  said  the  sickness  had 
returned  with  great  pain  in  the  right  groin.  It  was  again  stopped  by  a  recur- 
rence to  the  treatment  for  a  week.  The  whole  number  of  days'  rest  was  thir- 
teen or  fourteen.  On  the  28th  Mrs.  S —  was  able  to  take  four  meals  a  day, 
and  began  Iron  and  Quinine,  which  on  April  29th  she  was  going  on  with, 
h;ivinjr  had  no  return  of  her  sickness.  In  the  spring  of  1866  I  heard  from 
her  sister  that  she  had  continued  well  ever  since. 

In  a  former  case  (Esther  D — ,  CASE  CC),  the  agency  of 
complete  rest  to  the  stomach  and  of  shower-baths  may  have 
been  compared.  The  first  seems  more  calculated  to  work  a 
powerful  and  immediate  effect,  but  that  of  the  latter  was  more 
permanent.  In  the  next  case  I  trusted  to  shower-baths  at  once, 
and  with  apparent  success. 


VOMITING.  221 

:  (Till.— Miss  Frances  C— ,  aged  21,  a  younjrer  sister  of  tha  last 
patient,  is  ;t  very  plump  girl,  with  a  pink  and  white  doll's  complexion;  but 
when  >lie  th -t  earn.-  io  me,  on  the  4th  of  April  1866,  she  and  her  mother  posi- 
tively alii rmed  that  she  hardly  ever,  for  five  years,  passed  a  meal  without 
vomiting.  She  seems  a  calm,  sensible  person,  impressionable  perhaps,  but 
not  hysterieal.  She  says  that  by  a  violent  effort  she  can  keep  things  down; 
but  that  effort  produces  violent  pain  at  the  upper  part  of  the  sternum.  The 
vomiting  had  been  worse  and  her  efforts  to  restrain  it  more  ineffectual  since  a 
violent  purgative  course  which  had  been  administered  by  an  occulist  to 

an  inflammation  of  the  tarsi.  Since  then,  also,  her  bdfrels  had  been 
very 

!ered  her  a  cold  shower-bath  at  twelve  o'clock  every  day,  and  the  fol- 
lowing draught : — 

R. — Acidi  Hydrocyanic!  dil.  *n.iv, 
Tinct.  Valerianae  com  p.  fl^j, 
Infusi  Valerianaj  fl.5J. 
Bis  die  semi-horam  ante  cibum. 

On  the  12th  this  medicine  was  changed  for  four  drops  of  the  Prussic  Acid 
before  meals,  and 

R. — Zinci  Valerianatis  gr.  iij, 

Opii  gr.  $. 
Omni  nocte  et  mane. 

On  the  28th  she  called  to  show  herself  as  quite  well ;  but  she  purposed  to 
continue  the  shower-baths  every  morning  as  a  substitute  for  the  British  tub- 
bing. 

The  hereditary  nature  of  the  constitution  tending  to  this 
disease  is  shown  \>y  the  two  sisters  being  afflicted  in  a  similar 
\v:iv.  Si-rim:  their  mother  one  day  I  took  the  opportunity  of 
mining  her,  and  found  that  though  she  had  never  been 
subject  to  vomiting,  yet  she  used  to  have  regular  hysterical  fits 
when  a  maiden. 

Strong  mental  impressions  sometimes  have  a  singular  effect 
both  in  hriirjini:  on  and  stopping  chronic  vomiting  of  this  sort. 
An  np.-'-ttiirj-  .-hock  will  indu  :  a  calmative  control, 

or  the  idea  thereof,  will  arrest  it. 

Hannah  M — ,  a::et]  1'.'.  was  sent  to  me  by  Mr.  Ay  res,  of 

1!  mi-'_Mte.  in  January.  1-.  '  •  •  of  hysteria,  she  had  suffered 

daily  from   rejeetioii  of  food   for  six  months,  sometimes  throwing  up  every- 
thing euteil.  but  always   unehaiiired  in  aji;>i-aranee.      She   had   al-o  frequently 
•  .dlowinir.  so  immediate  w.t>  the  rising  ,,f  j]u.  Lr,,r^rt.  at  food. 

*  .ileriau,  and  -h*  I  well.     Then  .-he  went  home  to 


222  VOMITING. 

Ramsgate ;  and,  being  soon  afterwards  frightened  by  a  chimney  catching  fire, 
was  attacked  by  vomiting  again. 

She  returned  to  London  and  sent  for  me.  Immediately  on  my  visit — with- 
out any  remedy — the  vomiting  ceased,  and  she  swallowed  everything  easily. 
It  was  the  most  "veni,  vidi,  vici"  cure  I  ever  saw. 

The  cure  here  was  purely  moral.  And  of  shower-baths,  too,  I 
think  we  may  class  a  great  part  of  the  strength  among  psychical 
agents.  To  take  a;  cold  shower-bath  demands  a  certain  control 
over  the  wifc,  even  when  you  are  driven  into  it  by  a  stern  nurse, 
and  the  bracing  up  the  mind  to  the  resistance  to  the  instinctive 
shrinking  against  the  shock  is  the  best  possible  lesson  which  the 
physician  is  at  liberty  to  prescribe.  Strength  of  will  is  gained 
by  willing. 

I  have  already  said  that  I  looked  upon  the  temporary  paraly- 
sis of  the  oesophagus  as  the  most  essential  pathological  condition 
in  vomiting,  A  confirmatory  evidence  of  this  is  found  in  some 
cases 'where  temporary  paralysis  of  other  parts  is  exhibited  along 
with  the  vomiting.  I  extract  the  following  case  out  of  my  clini- 
cal lectures  for  1863  : — 

CASE  CCV. — I  will  call  your  attention  to  a  case  of  vomiting,  namely  that 
of  Hannah  P — ,  aged  18.  She  is  a  respectable  farmer's  daughter,  and  seems 
to  have  been  much  petted  at  home.  She  has  large  black  pupils  to  the  eyes, 
and  puffy  eyelids,  and  allows  that  before  her  present  illness  she  used  to  have 
hysterical  fits,  but  not  since  she  has  suffered  from  what  she  came  here  for, 
namely,  chronic  vomiting.  I  should  rather  call  it  a  rejection  of  food,  for  it 
occurs  even  while  food  is  being  taken,  almost  always  before  it  is  swallowed. 
This  happens  at  every  meal,  and  has  lasted  a  year  and  a  half,  and  during  that 
time  she  has  been  for  a  short  time  in  her  county  hospital  with  relief  but  not 
cure.  She  has  also  pains  in  the  back  and  in  the  splenic  region.  She  declared 
she  was  unable  to  walk  or  even  to  stand  without  assistance,  and  when  placed 
upright  in  the  middle  of  ttte  room  she  fell  down  at  first.  Nevertheless,  after 
a  scolding  and  a  decided  command  to  exert  her  will  vigorously,  she  at  last 
began  to  put  one  leg  before  the  other,  and  progressed  a  few  steps  even  on  the 
first  day.  The  catamenia  had  been  absent  three  months,  and  indeed  hud  never 
been  established  at  regular  periods. 

This  girl,  after  retaining  mutton-chops  and  porter  for  a  fortnight,  and  ex- 
hibiting her  muscular  powers  by  a  walk  to  Oxford  Street  and  back,  went  home 
well  July  13th.  While  in  hospital  (convalescent)  she  was  employed  about  the 
wards ;  and  being  thus  brought  in  contact  with  a  young  woman  recovering 
from  rheumatic  fever,  she  infected  her  also  with  a  desire  to  vomit,  which,  how- 
ever, was  checked  in  the  bud.  And  I  afterwards  heard,  from  one  of  my  pupils, 


VOMITI  223 


ho  next  winter  not  only  n-lajisi-d  into  IHT  former  condition,  but  again 
coinmuuirutfd  it  to  a  neighbor  of  her  own  age.       , 

There  is  a  peculiarity  about  hysterical  paralysis  which  in  a 
lee  to  its  nature  —  and  guiding  to  its  nature 

is  here  more  than  anywhere  a  most  important  step  in  the  cure. 

:i  you  set  the  patient  up  on  the  floor,  assisting  her  with  one 

or  two  hands,  or  with  your  hands  under  the  axilla?,  according 

to  the  degree  of  paralysis  and  the  amount  of  aid  wanted,  the 

is  immediately  thrown  forwards,  and  all  yo9r  strengtli  is 

called  tor  to  prevent  her  falling  on  the  face.     Other  paralytics 

fall  to  one  side  or  the  other,  or  backwards,  and  do  not  stumble 

forwards  in  this  way.     The  peculiarity  was  well  marked  in  the 

above  instance,  and  aided  the  diagnosis. 

So  also  in  the  vomiting  which  is  associated  with  it  in  its 
nature  there  is  a  peculiarity  which  is  a  diagnostic  guide.    It  can 

rally  be  controlled  by  a  violent  effort  of  the  volition. 
And  thus  to  exert  the  volition  is  a  help  not  only  to  the  diag- 
3,  but  to  the  cure,  as  has  been  shown  by  several  instances 
of  a  typical  sort. 

Mention  was  made  in  a  parenthetic  addition  to  the  history  of 

this  last  case  of  the  communicability  of  this  kind  of  complaint. 

an  instance  of  the  mysterious  power  of  sympathy  which 

influences  so  much  of  our  outward  life  from  the  cradle  to  the 

•  .     In  this  instinct  of  imitation  there  are  indeed  de^1 
but  no  essential  differences  between  that  which  helps  the  infant 
to  acquire  the  power  of  speech,  and  that  morbid  condition  in 
which  the  mind  and  body  are  slavishly  enchained  to  reflect  the 

engendered  by  the  feelings  of  another.     It  is  innate  in  all, 
but  is  weak  or  strong  in  proportion  as  the  mind  is  capable  of 

2  alone,  or  is  necessarily  in  the  habit  of  depending  on 
others.     This  is  the  reason  why  it  prevails  so  much  among  the 
female  sex.      I  have  had  so  many  instances  of  hysteria,  ci 
and   allied    «i  Ifhoee    pathology    lies    between    mind    and 

matter,  lieinir  caught  by  lookers-on,  that    I   cannot    h. 
call  their  transmit-  >n  an  infection  by  the  c\ 

e  must  be  taken  to  distinguish  from  tl.:  of  cases 

•  in  which  from  some  mechanical  impediment  <>r  le.-i.m  the 
f»"d  cannot  be  swallowed,  such  as  that  cited   in  illustration  of 


224  VOMITING. 

another  part  of  the  subject  at  page  194,  or  the  following,  where 
the  result  being  happier,  more  doubts  might  have  been  expressed 
as  to  the  diagnosis. 

CASE  CCVL— A  respectable  cabman's  wife,  Ann  A — ,  aged  32,  was  ad- 
mitted to  St.  Mary's  July  22d,  1853.  She  was  exceedingly  emaciated,  weak, 
anasmic,  and  had  a  loud  murmur,  probably  from  anaemia,  with  the  first  sound 
of  the  heart.  For  a  month  she  had  been  obliged  to  reject  her  victuals  after 
chewing  them,  from  inability  to  pass  them  further  than  the  back  of  the  throat. 
They  seemed  to»etick  at  the  level  of  the  os  hyoides.  From  this  point  a  pain 
ran  to  the  back  of  the  neck,  between  the  shoulders.  Quite  at  the  posterior 
part  of  the  fauces  the  mucous  membrane  looked  redder  than  elsewhere,  and 
was  redder  still  lower  down. 

She  was  ordered  rations  of  beef-tea  and  milk,  and  the  following  electuary : — 

R. — Bismuthi  Trisnitratis  3J, 

Sacchari  fsecis  3iss. 
Fiat  electuarium  quotidianum,  cujus  lambat  panxillum  subinde. 

When  able  to  swallow  better,  she  had  some  Bark  and  a  blister  on  the  throat. 
She  lost  the  pain,  was  able  to  swallow,  and  left  much  relieved  on  August  7th. 

It  will  be  seen  here  that  the  food  is  not  swallowed  at  all,  and 
there  is  no  emetic  effort.  It  is  simply  rejected. 

I  am  glad  of  the  opportunity  in  citing  this  case  of  again 
recording  the  good  effects  of  Bismuth,  alluded  to  under  Case 
CLXIV. 

To  sum  up,  I  would  deduce  from  the  very  common  class  of 
cases  of  which  I  have  cited  typical  examples : — 

1st.  That  the  chronic  vomiting  of  matters  swallowed  un- 
changed immediately  after  swallowing  is  almost  peculiar  to 
women. 

2d.  That  it  is  allied  to  hysteria. 

3d.  That,  like  hysteria,  it  is  now  more  a  mental,  now  more  a 
bodily  affection ;  now  more  under  the  patient's  control,  now  less. 

4th.  That  the  efficient  employment  of  drugs  being  in  a 
manner  barred  by  their  rapid  ejection,  other  means  are  more 
imperatively  called  for  in  this  disease  than  in  most  others. 

5th.  That  the  weakening  of  the  patient's  will  being  the 
marked  feature  of  this  morbid  constitution,  the  strengthening 
of  the  will  is  the  best  antidote. 

6th.  Rational  persuasion  is  available  in  some  few,  extremely 
voluntary,  cases. 


V  n M  I  T  225 

7th.  The  most  powerful  remedy  is  the  cold  shower-bath,  for 
the  reasons  irivfii  above. 

8th.  When  physic  can  be  retained,  the  most  efficient  is 
i;in. 

i'th.  A  forcible  change  of  habit  by  resting  the  stomach,  and 
Diving  it  nothing  to  bring  up,  is  a  valuable  aid ;  but  it  is  doubt- 
ful how  tar  it  wuuld  answer  without  other  remedies. 

SECTION  VIII. 
1 '  nonary  consumjition. 

VII. — Cyrus  K  — .  u<_"-.i  '-"-'.  ' Mine  in  July,  18.").").  with  a  complaint 
of  laniMiMi-.  sleepiness  of  an  afternoon,  weight  at  the  epigastrium  an  hour  or 
two  after  meals,  and  occasional  vomiting  in  the  morning.  He  had  had  a  good 
deal  of  hard  work  latterly,  and  attributed  his  indigestion  to  that.  But  his 
mentioning  a  cough  induced  me  to  examine  his  chest,  where  I  found  marked 
deh'c-ienry  t.f  respiration  and  dtilness  in  the  apex  of  the  left  lung,  and  crack- 
ling in  the  lower  lobe  of  the  same  side,  lie  was  also  a  good  deal  emaciated, 
and  he  owned  to  having  spat  blood  before  he  was  ill.  I  thought  there  was 
tuben-le  just  beginning  to  soften ;  gave  him  for  a  time  Lime-water  and  milk, 
Coil-liver  Oil.  and  Steel  \Vine  after  meals.  And  then  I  urged  him  to  go  to 
the  West  Indies,  where  he  had  connections,  for  the  winter. 

In  October,  l.-t'.l.  he  came  again,  telling  me  that  he  had  gone  to  Bermuda 
and  stayed,  not  only  for  the  winter,  but  ever  since.  In  1858  be  had  spit  tin*; 
of  blood,  and  he  had  yellow  fever  in  1859,  but  had  grown  fat  in  spite  of  them  ; 
and  he  had  continued  well  till  he  was  now  come  to  England,  where,  after  a 
few  months'  holiday,  he  found  his  old  dyspepsia  returning,  and  was  wisely  re- 
>ol  ved  to  go  back  to  his  more  appropriate  home.  There  was  crackling  in  the 
apex  previously  dull,  but  I  do  not  think  the  lungs  had  got  materially  worse. 

This  is  the  slightest  degree  of  stomach  derangement,  for  it 
did  not  even  prevent  the  taking  of  Cod-liver  Oil. 

V  1 1 1. — An  unmarried  lady  of  32  was  sent  up  to  town  for  my  opi- 
nion by  Mr.  Gardner,  of  1'aiuswick.  May  Hiid,  IM'.:>.  She  had  l>een  ill  since 
the  previous  October  with  vomiting  after  meals.  The  food  returned  at  short 
intervals  in  mouthfuls  in  an  undigested  state.  '1  lie  matters  rejected  were 
almost  always  free  from  aridity.  Sometimes  this  would  begiu  in  the  morning 
and  continue  all  day.  sometimes  would  not  come  on  until  the  evening. 

She  had  a  slight  feeling  of  weight  or  oppres.-ioii  at  the  epigastrium,  but 
there  was  no  distension  or  tenderness. 

Her  general  health  had  not  sum-red  much,  the  meii-es  remaining   regular, 
and  at   these  periods  she  thought  she  was   better.     Though  she.  haii 
cough,  it  was  not  a  marked  feature  in  the  ca 

15 


226  VOMITIXG. 

On  examining  the  chest,  I  found  evidence  of  crude  latent  tubercle  in  the 
lungs.  There  was  deficient  respiration  in  the  right  apex,  and  a  bronchial 
interrupted  expiration  in  the  left. 

The  degree  of  dyspepsia  and  the  degree  of  tuberculosis  are 
not  proportioned  to  one  another.  There  was  in  this  case  much 
more  vomiting  and  less  tubercle,  or  less  advanced  tubercle,  than 
in  the  last.  Perhaps  it  was  because  of  the  patient's  sex. 

CASE  CCIX. — William  J — ,  aged  21,  was  admitted  to  St.  Mary's  August 
21,  1857,  for  pulmonary  consumption  of  two  years'  duration.  (The  upper 
part  of  the  chest  was  much  flattened,  and  the  shoulders  drawn  forwards ; 
there  was  bronchophony  and  bronchial  breathing,  and  various  creaking  rales 
in  the  apices  of  both  lungs,  most  in  the  right.)  He  suffered  from  several 
dyspeptic  symptoms,  and  among  them  from  vomiting.  He  stated,  however, 
that  this  latter  only  occurred  if  he  attempted  to  move  about  and  take  bodily 
exercise  after  meals. 

He  was  able  to  keep  down  Cod-liver  Oil  if  he  remained  quite  quiet  after- 
wards; and  upon  that,  and  Iron  after  meals,  he  gained  two  pounds  in  weight 
between  August  28th  and  September  5th.  He  was  then  treated  for  a  week 
with  Hyposulphite  of  Lime  (eight  grains  three  times  a  day) ,  but  gained  only 
one  pound  in  that  time.  His  sickness  never  troubled  him  as  long  as  he  kept 
quiet  and  rested  in  the  hospital. 

The  sickness  only  on  exertion  looked  as  if  it  depended  on 
general  weakness,  rather  than  on  any  morbid  condition  of  the 
stomach. 

I  introduced  the  last  clause  in  the  history,  not  as  especially 
bearing  on  consumptive  vomiting,  but  to  take  an  opportunity 
of  saying  that  I  have  not  found  Hyposulphite  of  Lime  such  a 
good  renewer  of  life  as  Cod-liver  Oil.  Some  consumptive 
patients  did  not  gain  any  weight  at  all  under  its  use,  in  spite  of 
the  improved  diet  of  the  hospital. 

The  next  two  cases  exhibit  the  coming  on  of  vomiting  in 
consumption  coincident  with  the  first  haemoptysis. 

CASE  CCX. — Emma  K — ,  aged  25,  was  sent  from  a  penitentiary  to  St. 
Mary's  Hospital,  on  account  of  her  failing  health,  July  22d,  1853.  She  des- 
cribed herself  as  having  been  weakly  for  a  couple  of  years,  but  had  no  marked 
symptoms  till  a  fortnight  before,  when  she  began  coughing  up  blood.  At  the 
same  time  she  commenced  vomiting,  and  continued  to  throw  up  everything 
she  took.  She  was  rapidly  losing  flesh. 

On  stethoscopic  examination  the  apex  of  the  right  lung  was  found  dull  and 
very  painful  when  pressed. 


VOMITING.  227 

"  (Jnllir  Acid  (for  the  haemopn-;-  .   Hydrocyanic  Acid,  Morphia.  Quinine, 

.illy  given,  without  any  advantage  to  the  sickness.     Chloroform  in 

c-i^lit  miuiin  doses  was  of  temporary  use.  but  the  most  effectual  remedy  was 

Opium  in  grain  doses.     Under  this  her  sickness  ceased,  and  she  immediately 

:    to   gain  flesh  and  strength,  and  left  the  hospital  in  fair  condition 

181  'JlUli. 

"With  the  vomit  there  was  at  first  a  good  deal  of  light  green  fluid,  probably 
bltMid  swallowed  and  digested. 

\I.     Bridget  S — ,  a  domestic  servant,  was  admitted  to  St.  Mary's 
January  L'llth.  K>7.  with  pulmonary  consumption  of  eighteen  months'  dura- 
tion.    It  had  liegun  with  hemoptysis  and  vomiting.     The  vomit  usually  was 
merely  the  contents  of  tin-  >toiua«-h.  but  sometimes  she  brought  up  clots  of 
i  at  the  same  time. 

The  good  effects  of  Opium  in  checking  the  vomiting  of  con- 
sumptives was  alluded  to  in  CASE  CCX ;  the  following  illus- 
trates it  still  more  strongly. 

CCX II. — B.'s  Anonyma,  aged  about  five-and-twe.nty,  was  placed 
under  my  (are  in  March.  1861.  She  had  a  large  vomica  in  the  upper  lobe  of 
the  left  luug.  and  the  greater  part  of  the  lower  lobe  impervious  with  tubercles ; 
but  .-he  had  suffered  very  little  from  pulmonary  symptoms,  would  not  h< 
her  being  in  a  consumption,  and  talked  ubout  going  to  dances  in  a  low  dress 
as  soon  as  she  could  get  about  again.  But  she  was  utterly  prostrated  to  her 
bed  by  the  constant  vomiting  of  all  she  ate,  and  retching  when  she  ate 
nothing.  The  bowels  were  obstinately  costive,  and  she  had  taken  as  much  as 
twelve  grains  of  Kxtract  of  Colocyuth  without  efl'ect, 

\e  !MT  Opium,  beginning  with  a  grain  and  augmenting  it  to  six  grains 
daily.     Then  the  vomiting  ceased,  and  she  recovered  her  appetite  and  fond- 
er luxurious  living.     She  ate  twelve  shillings'  worth  of  strawberri 
April'  daily,  and  an  immeasurable  quantity  of  brown  bread  ice.     Her  bowels 

••red  their  functions,  and  she  pa.-sed  naturally  colored  and  formed  Bt 
in  spite  of  the  Opium.     She  slept  naturally  and  easily  without  excess  or 
stupor. 

She  died  in  the  summer,  but  was  able  to  keep  off  her  vomiting  to  the  last 
by  the  help  of  the  Opium.  I  think,  however,  she  increased  the  dose.  So  that 
her  ending  was  made  much  more  easy,  and  probably  postponed  by  it. 

A  diiVeivnt  fonn  of  phthisical  vomiting,  sadly  common,  is  that 
which  occurs  in  an  advanced  stage  of  lar^c  vomica',  from  the 
nans.  of  the  sputa.  It  is  very  distressing  to  the  patient; 

and  almost  equally  so  to  tin-  physfciau,  for  his  remedies  all'ord 
little  or  no  relief. 

This  vomiting  is  more  frequently  found  when  the  vomica 
occupies  the  lower  or  middle  parts  of  the  lung  than  when  it  is 


228  VOMITING. 

at  the  apex,  for  the  reason  that  in  these  first-named  situations 
the  cavity  is  more  apt  to  eat  itself  into  the  neighborhood  of  the 
ribs,  and  it  is  the  contact  of  bone  which  makes  the  pus  grow  so 
horribly  fetid. 

CASE  CCXIII. — Captain  H — ,  a  man  of  fine  build  and  healthy  family,  aged 
about  36,  came  under  me  in  August,  1862.  He  had  long  been  subject  to 
cough,  but  had  never  spat  blood.  His  complaint  was  of  considerable  pain  in 
the  right  side,  which,  as  an  old  Indian,  he  attributed  to  what  they  call  "liver." 
In  the  lower  lobe  of  that  lung  there  were  dispersed  cracklings  to  be  heard 
with  the  ear,  and  there  was  slight  general  dulness  on  percussion  diffused 
through  the  lobe.  This  was  in  front ;  behind  the  sounds  were  healthy.  The 
sputa  consisted  of  transparent  mucus. 

Leeches  and  Chloroform  considerably  relieved  the  pain  for  the  time,  so  I 
suppose  it  was  dependent  partly  on  pleural  inflammation. 

In  October  of  the  same  year  his  pain  in  the  side  was  less  sharp.  The  ex- 
pectoration and  cough  were  worse.  There  was  very  marked  dulness  with 
absence  of  respiration  in  the  right  infra-mammary  and  infra-scapular  regions. 
He  went  to  the  South  of  France  for  the  winter. 

In  the  May  of  1863  I  saw  him  again.  He  suddenly,  during  a  violent  fit  of 
coughing,  had  thrown  up  a  pint  of  pus,  and  continued  coughing  it  up.  If 
the  cough  ceased  for  a  little  time,  the  pus  would  collect,  and  then,  on  being 
expectorated,  tasted  and  smelt  so  intolerably  nauseous  that  vomiting  inva- 
riably was  produced.  This  took  place  always  every  morning,  when  the  matter 
had  collected  during  the  night. 

I  one  day  examined  some  of  this  fetid  sputa  under  a  microscope,  and  found 
pus-globules  of  various  sizes,  some  regular  and  normally  granular,  some  swol- 
len and  exhibiting  their  nucleus,  fat  in  globules,  granular  masses  (?  rotten  fat), 
tabular  crystals  of  cholesterine,  and  spicular  crystals  which  my  microscopic 
lore  was  not  sufficient  to  enable  me  to  identify.  It  was  anything  but  "  laud- 
able." 

Poor  Captain  H —  was  very  patient,  but  a  more  distressing  case  I  have 
rarely  seen,  so  excessive  was  the  disgust  from  the  constant  vomiting  and 
fetor  of  the  expectorata. 

He  got  a  little  better  for  a  time  at  Malvern  in  the  summer,  and  was  kept 
from  sinking  by  Cod-liver  Oil  and  Quinine.  But  the  abscess  or  vomica  never 
healed  up,  and  continued  to  secrete  fetid  pus.  The  dulness  on  percussion 
also  increased  in  extent,  so  that  there  was  scarce  any  breathing  over  the 
whole  lung ;  I  supposed  that  a  fresh  deposit  had  taken  place  of  tubercle,  or 
whatever  other  matter  solidified  the  pulmonary  tissue.  He  died  at  Lisbon 
the  next  winter  in  an  extreme  state  of  consumption.  However,  he  never  had 
any  diarrhoea.  • 

The  vomiting  and  fetid  expectoration  never  seemed  bettered  by  any  medi- 
cine, except  perhaps  Quinine,  and  that  he  could  take  very  little  of,  such  a 
headache  it  gave  him. 


VOMITING.  229 

It  is  impossible  to  bring  to  bear  on  a  pulmonary  lesion  any 
of  the  usual  applications  that  surgeons  make  to  fetid  absce 
or  else  in  siu-h  a  case  as  the  above  one  would  be  glad  to  use 
them.     To  bore  an  opening  through  the  thoracic  walls  would 
ably  be  a  great  comfort  to  the  patient  and  a  prolongation 
of  life;  and  I  should  be  glad  to  find  the  operation  consented  to. 
IJut  it  is  impossible  conscientiously  to  speak  of  it  as  likely  to 
•  a  cure,  and  naturally  the  knife  is  shrunk  from — I  do  not 
expect  ever  to  try  it. 

SECTION   IX. 
Occasional  causes  of  vomiting. 

('('XI  V. — Wilson  M — ,  aged  29,  a  coach-painter,  was  taken  in  by  me 
at  St.  Mary's  Hospital  the  morrow  of  Christmas  Day,  IHG'2.  He  had  always 
tieen  a  strong  man  till  the  middle  of  November,  when  he  was  aware  of  a  pain 
across  the  loins  and  down  the  thighs,  a  tightness  across  the  belly,  and  head- 
ache. At  thi-  same  time  he  noticed  first  his  face,  then  his  body,  swollen  of 
a  morning  before  going  to  work.  He  got  himself  cupped  in  the  loins,  but 
thought  it  did  the  pain  no  good. 

On  admission,  the  whole  person  was  anasarcous ;  the  pain  in  back  and 
belly  remained  ;  the  bowels  were  regularly  open  once  a  day;  his  appetite  for 
food  was  sufficient ;  his  thirst  more  than  natural ;  the  urine  was  albuminous, 

•anty,  of  the  specific  gravity  l.ol'J. 

Hot  oaths,  a  dose  of  Jalap,  and  Nitre  draughts  three  times  a  day,  were 
prescribed.  He  was  kept  in  bed. 

On  the  3lst  of  December  the  legs  were  natural,  and  on  the  3d  of  January 
J  anasarca  was  nearly  gone.     He  was  ordered — 
li. — Tiucturac  Ferri  Scsquichloridi  n\,xv, 
Tinetnra-  l>i;:iialis  n\,x. 
Mist  lira-  ('amphora'  tl^j — Ter  die. 

During  the  use  of  this  his  feverish  thirst  diminished.  He  was  made  an 
out-patient  ou  January  Kith,  his  urine  remaining  albuminous. 

On  the  iMh  <>!'  I-Yliruary  he  was  readmitted  as  too  ill  to  be  an  out-patient. 
He  had  In-come  very  feverish  and  thirsty  ai_'ain,  his  tongue  was  white,  and  he 
had  di/./.iness  of  head  and  oli.-eiiration  of  ey>ii_r|it.  At  the  same  time  lie  had 
ittaeked  with  vomiting,  and  thrown  up  as  many  as  twelve  times  in  the 
day.  He  had  no  return  at  all  of  the  dropsy,  though  the  urine  remained 
altiuminous. 

A  <:  11  lied   reduced  the  frequency  ..f  the  vomiting  to  once  a  day. 

Itut  that  and  the  leveri.-hne<-;  contained  for  several  days  longer.    Hydrocyanic 
.-  d  to  do  him  gi 


230  VOMITING. 

This  case  shows  that  it  is  the  albuminuria,  and  not  the  dropsy 
(as  some  have  suggested),  which  causes  vomiting  in  Bright's 
disease.  I  think  it  very  likely  that  the  gastric  glands  may  in 
the  more  obstinate  of  these  cases  be  degenerated  after  the  same 
fashion  as  the  kidneys.  In  a  continuous  series  of  a  hundred 
post-mortem  examinations  recorded  by  Dr.  Handfield  Jones  in 
the  "Medico-Chirurgical  Transactions"  for  1854,1  out  of  twenty- 
four  cases  of  real  degeneration  only  seven  had  the  glandular 
structure  of  the  stomach  completely  healthy. 

CASE  CCXV. — Ann  F — ,  aged  52,  married,  was  admitted  under  me  at  St. 
Mary's  March  18th,  1853,  complaining  of  a  general  throbbing,  faintness,  and 
what  are  recorded  in  the  book  as  "general  dyspeptic  symptoms,"  of  which 
the  most  marked  were  vomiting  and  tightness  across  the  chest. 

On  auscultatory  examination,  the  ribs  were  found  rounded  and  immovable, 
and  the  cardiac  region  overlapped  by  emphysematous  lung,  so  as  to  be,  with 
ali  the  rest  of  the  chest,  unnaturally  resonant. 

Hydrocyanic  Acid  and  Chloroform  relieved  the  dyspeptic  symptoms  some- 
what. The  remainder  of  the  history  has  no  bearing  on  my  present  subject. 

CASE  CCXVI. — Jane  K — ,  aged  27,  having  had  a  distorted  spine  from 
childhood,  it  was  impossible  to  ascertain  precisely  the  anatomical  condition 
of  the  lungs ;  but,  as  the  heart  was  healthy,  the  probability  is  that  the  short- 
ness of  breath  she  suffered  from  arose  from  pulmonary  emphysema.  The 
reason  of  her  coming  into  St.  Mary's  in  June,  1856,  was  frequent  vomiting, 
which  exhausted  her  very  much.  This  did  not  occur  in  any  relation  to  meals, 
but  at  night.  She  was  benefited  by  Hydrocyanic  Acid,  a  Jalap  purge,  and  a 
fortnight's  rest ;  after  which  she  went  out  without  complaint. 

It  is  worthy  of  remark  how  the  worst  time  of  the  twenty -four 
hours  for  the  lungs  of  the  broken- winded  is  also  the  worst  for 
their  stomach.  It  is  at  night  that  their  paroxysms  of  dyspnoea 
come  on,  and  at  night  this  woman  had  hers  of  vomiting. 

Dr.  Hyde  Salter,  in  his  useful  monograph,  remarks:  "It  is 
very  rare  to  see  an  asthmatic  with  a  perfectly  sound,  strong 
stomach,  about  which  he  has  never  to  think,  and  in  the  history 
of  whose  case  dyspepsia  has  no  place.  Sometimes  the  dyspeptic 
symptoms  exist  in  a  very  aggravated  form,  and  they  are  fre- 
quently such  as  to  imply  that  the  stomach  disturbance  is  one 
of  deranged  innervation — that  its  sensibility,  or  its  movements, 
or  the  nervous  superintendence  of  its  secretion  is  perverted.  In 

Vol.'xxxvii.  page  87. 


VOMITING.  231 

he  stomach  and  lung  symptoms  are  part  of  one 
morbid  condition;  the  whole  thing  is  deranged  pneumogastric 
inncrvation,  the  dyspeptic  symptoms  being  the  manifestation  of 
the  irastric  portion  of  this  deranged  innervation,  and  the  asthma 
of  the  pulmonary  portion  of  it."  He  gives  then  a  good  example 
of  the  alternation  of  the  diseases,  asthma  and  vomiting.1 

It  has  been  observed  already,  in  CASE  LI  (page  75),  that 
liquids  often  disagree  more  than  solids  with  emphysematous 
and  cardiac  asthmatics. 

Some  cases  of  intermittent  vomiting  seem  connected  with 
ague  poison. 

('•XVII. — Stephen  A — .  aped  54,  an  active,  well-to-do  farmer  from 

the  marshy  neighborhood  of  Colchester,  came  to  town  to  consult  me  May 

I'ltli.  l-i'.n.     Hi-  stated  that  he  had  always  been  a  temperate  man,  and  ap- 

•1  to  speak  the  truth.     He  had  suffered  from  weight  at  the  pit  of  the 

stomach,  especially  in  wet  weather,  for  near  upon  ten  years,  and  at  various 

times  has  occasionally  thrown  up  some  stringy  phlegm  from  the  stomach. 

rie  i-iit'irrh.     See  "  Weight.")     In  the  summer  of  1859  he  had  rather  a 

severe  touch  of  ague,  which  pulled  him  down  a  good  deal,  and  he  had  never 

Keen  quite  the  same  man  since.    The  stools  were  sometimes  "yeasty,"  some- 

'lark,  rarely  natural.    Since  his  ague  he  had  vomited  every  other  day, 

and  at  tin-  time  of  the  vomiting  had  a  spasmodic  pain  just  beneath  the  en- 

sifiirm  cartilage.     He  occasionally  had  vomiting  and  occasionally  had  pain  at 

other  times,  lnit  seemed  pretty  clear  as  to  their  general  tertian  character.     I 

ordered  him  five  grains  of  (Quinine  every  night  and  morning,  and  as  I  did  not 

hear  of  him  again  I  presume  it  was  sufficient  to  effect  a  cure. 

In  the  following  case,  a  living  irritant  seemed  the  cause  of 

vomiting. 

•  (VXVIII.— Uridget  W— ,  aged  20,  spinster,  was  admitted  to  St. 
Mary's  January  llth.  l-t>l.  She  had  very  obstinate  vomiting,  especially  in 
tin-  morning,  which  resisted  Oxalate  of  Cerium,  Bismuth,  and  Pepsine,  which 
wer«-  severally  tried.  Of  the  three,  Pepsine  seemed  of  most  use.  Then  she 
had  a  diarrlm-a.  ami  parsed  two  worms  (prolialily  the  ordinary  Round-worm, 
lint  I  did  not  see  them).  It  was  found  that  she  had  been  very  subject  to 
wcnins  since  the  age  of  fourteen,  and  was  of  a  very  mucous  diathesis,  having 
lem  nrrhiea  and  frequent  catarrhal  coughs.  She  was  ordered  Turpentine,  but 
I  have  no  note  of  the  result. 

II  t-rnati'mesis  has  been  spoken  of  as  the  result  of  violence. 
Chronic  vomiting  also  m.iy  U:  produced  by  the  same  cause. 

1  Salter,  "On  Asthma,"  chapter  xii.  section  a,  page  216  (Edit,  of  1860). 


232  VOMITING. 

CASE  CCXTX. — George  S — ,  aged  21,  a  porter,  was  admitted  to  St.  Mary's 
September  25th,  1858.  He  had  had  a  fall  six  months  previously,  cutting  his 
head  and  otherwise  knocking  him  about.  He  was  very  giddy  afterwards,  and 
felt  a  violent  pain  near  the  navel,  to  which  Leeches  were  applied  with  relief. 
The  pain  extended  backwards  to  between  the  shoulders.  The  next  day 
vomiting  of  nearly  all  ingesta  commenced,  and  continued  more  or  less  all  the 
six  months. 

On  admission,  there  was  dulness  on  percussion,  and  tenderness  to  the  right 
of  the  epigastrium  ;  but  this  proved  afterwards  to  be  due  to  feces  impacted  in 
the  colon. 

The  vomiting  was  very  constant.  He  was  obliged  to  be  fed  on  a  couple  of 
mutton-chops  very  slightly  done  and  pounded  up,  of  which  a  teaspoonful  was 
given  every  two  hours  with  a  little  milk.  He  had  fifteen  grains  of  Pepsine 
every  four  hours.  But  he  kept  on  vomiting,  and  lost  2£  Ibs.  in  weight. 

On  October  9th  he  was  put  upon  Liquor  Calcis,  and  milk  and  beef-tea,  con- 
tinuing the  Pepsine.  Then  he  did  not  vomit  for  eighteen  days,  and  got  back 
to  meat ;  but  had  to  leave  it  off  after  a  few  days  and  resume  the  liquid.  He 
gained  at  one  time  six  pounds  in  weight  while  free  from  vomiting,  but  lost 
some  of  it  during  a  relapse. 

A  good  deal  of  hard  feces  was  brought  away  by  clysters,  apparently  with 
relief. 

He  complained  of  much  pain  in  the  epigastrium,  which  was  relieved  by  a 
Blister  dressed  with  Acetate  of  Morphia  sprinkled  on  the  raw  surface. 

He  got  gradually  better,  with  occasional  relapses;  due  perchance  to  impru- 
dences, and  was  discharged  November  24th. 

The  pathological  explanation  of  this  case  I  take  to  be  partial 
paralysis  of  the  intestinal  canal  by  a  sudden  shock  to  the  solar 
plexus,  very  much  as  the  voluntary  nerves  are  paralyzed  in  a 
concussion  without  lesion  of  the  brain.  This  would  account  for 
the  loss  of  vitality  in  the  colon  and  stomach  and  oesophagus  at 
the  same  time.  Remark  how  gradual  and  slow  was  this  man's 
restoration. 

In  all  physical  lesions  of  the  nervous  tissue,  the  main  ele- 
ments in  the  treatment  are  time  and  repose.  With  these  the 
foolishness  of  prescriptions  scarce  impedes  the  cure ;  without 
these  the  most  judiciously  selected  means  fail.  The  slowness 
of  renewal  is  very  distinctive  of  the  nervous  system,  and  is  ex- 
plained in  a  great  measure  by  the  difficulty  exhibited  in  that 
tissue  of  parting  with  its  substance  by  vital  metamorphosis.  In 
his  experiments  on  the  effects  of  inanition,  M.  Chossat,  com- 
paring the  losses  of  substance  in  different  tissues,  found  that  the 
nervous  suffered  least;  and  indeed  it  retained  its  full  weight 


VOMITING.  233 

after  several  weeks'  starvation.1  It  is  the  true  ultimum  mortens 
of  physiological  interstitial  decay,  and  of  course  it  is  the  last  and 
slowest  renewed. 

I  have  already,  in  a  chapter  on  the  social  habits  leading  to 
indigestion,  given  examples  of  alcohol  as  an  occasional  cause  of 
chronic  vomiting  ;*  but  I  omitted  to  mention  a  drug  which  I 
have  found  useful  in  that  complaint.  It  was  first  used  in  this 
way  by  Dr.  Marcet. 

:  ('('XX.  —  Jonathan  B  —  ,  a  middle-aped  gentleman,  asked  my  advice 
in  May.  lst',1.  for  nervous  trembling,  indigestion  of  food,  and  vomiting,  arising 
from  indulgence  in  spirit-drinking  between  meals  and  in  the  forenoon.  I  gave 
him 

R.—  Zinci  Oxidi. 

Pilulaj  Aloes  cum  Myrrha,  aa  ^iss. 
M.  fiaut  pilul.r  xx,  quurum  sumat  unam  ter  die. 

After  taking  these  for  ten  days,  as  he  afterwards  informed  me,  he  was  quite 
well.  Of  course  he  had  left  off  the  excess  of  alcohol.  Still  I  think  the  Zinc 
was  useful. 

(  '(  '  X  XI.  —  Charles  W  —  .  a  patient  with  tubercular  lungs,  who  used  to 
consult  me  in  the  spring  of  1862,  had  lodgings  at  Greenwich  in  an  open  situa- 
tion for  the  sake  of  the  air.  He  seemed  to  get  all  the  worse,  and  took  to 
vomit  inir  in  the  morning,  and  having  pain  in  the  epigastrium.  He  always  felt 
so  much  better  during  the  day,  and  got  so  much  worse  during  the  night,  that 
1  \vu-  led  to  inquire  more  particularly  into  the  peculiarities  of  his  Im!. 
I  liranl  liis  bedroom  was  colored  green,  and  on  his  bringing  by  my  desire  a 
of  the  wall-paper,  I  found  it  tinted  with  a  light  powdery  arsenite  of 
copper.  He  lost  the  dyspeptic  symptoms  when  he  changed  his  apartments. 

I  feel  no  doubt  that  here  the  arsenicated  water  color  was  the 
cause  of  the  vomiting,  though  that  is  not  its  universal  effect. 
When  made  into  an  oil  paint,  Scheele's  green  is  not  nearly  so 
dangerous. 

Mechanical  compression  of  the  epigastrium  by  tight  lacing, 
and  l>y  handicrafts  whore  that  part  is  exposed  to  injury,  has 
alrcadv  been  spoken  of  as  a  (MOM  of  rinetic  Indigestion.  Another 
mechanical  cause  is  umbilical  hernia,  though  I  cannot  now  lay 
my  linger  on  a  ease  in  point  —  I  have  m;i<lf  an  error  in  tran- 


expcrimentales  sur  I'lnanition,"  Paris,  1843,  page  91. 
Page  1  - 


234  VOMITING. 

scribing  the  reference.  I  do  not,  of  course,  refer  to  the  acute 
vomiting  of  strangulated  hernia,  but  to  chronic  vomiting. 

Allied  to  these  mechanical  causes  is  cancer  of  the  stomach 
and  parts  adjoining,  which  often  causes  vomiting.  Cases  of 
this  and  of  ulcer,  however,  I  will  postpone  to  a  chapter  on  the 
morbid  anatomy  of  the  stomach,  for  they  illustrate  that  much 
better  than  they  do  the  phenomena  of  indigestion.  And  the 
same  may  be  said  of  gouty  inflammation  of  the  stomach. 

Whether  the  vomiting  of  pregnant  women  will  be  capable  of 
explanation  on  mechanical  principles,  or  whether  we  are  to  look 
to  increased  knowledge  of  the  nervous  functions  to  interpret  it 
to  us,  is  doubtful.  Its  occurrence  in  the  morning  might  favor 
either  view,  for  there  is  both  a  change  of  mechanical  relations 
in  a  change  of  posture,  and  also  a  marked  weakness  of  nerve 
force,  at  that  hour.  The  vomiting  of  pregnancy  may  often  be 
stopped  by  directing  the  patient  to  leave  off  alcoholic  beverages, 
of  which  the  feelings  'of  weariness  from  having  to  drag  about 
an  extra  weight  and  general  lowness  of  spirits  often  induce 
women  to  consume  an  extra  quantity  during  their  breeding. 
Instead  of  taking  more,  they  ought  to  take  less  alcohol  than 
usual  at  that  time;  instead  of  blunting  their  vitality,  they  ought 
to  leave  it  free,  for  it  has  its  fullest  work  to  do.  A  simple  milk 
diet,  guarded  by  alkalies,  for  a  few  days,  will  frequently  quite 
check  the  vomiting  of  pregnancy. 

Vomiting  the  food  first  taken  seems  sometimes  to  arise  from 
simple  nausea  consequent  on  taking  food  with  repugnance,  and 
is  then  curable  by  remedies  which  awaken  a  natural  appetite. 
For  instance — 

CASE  OCX XII. — Amelia  D — ,  aged  20,  was  admitted  to  St.  Mary's  June 
19th,  1857.  On  admission,  her  general  condition  was  as  follows :  stature 
small ;  weight  84£  Ib. ;  complexion  fair;  skin  healthy ;  pulse  92,  even,  feeble  ; 
tongue  clean,  flabby;  bowels  daily;  urine  normal;  catamenia  monthly. 

She  was  well  fed,  and  not  overworked ;  but  her  employment  necessarily 
confined  her  a  good  deal  to  the  house.  The  thorax  was  healthy,  though  she 
told  a  tale  of  having  had  cough  and  haemoptysis. 

She  complained  of  pain  in  the  left  side,  and  sickness  in  the  morning,  espe- 
cially after  breakfast.  Her  appetite  was  very  bad,  and  the  sight  of  food  made 
her  gorge  rise  at  it ;  but  still  she  forced  herself  to  eat. 

She  was  at  first  dieted  on  milk  guarded  with  Lime-water,  rice-pudding  and 
ice,  and  took  a  grain  of  Opium  every  night. 


VOMITING.  235 

But  after  five  <1nys  she  was  no  better,  so  the  Opium  was  left  off,  and  ten 
grains  of  Bouiluult's  IVp-ine  powder  three  \i\\\>-<  n  day  suhstituted  for  it. 

In  three  .lays  her  appetite  had  returned,  the  vomiting  and  nansea  had 
i.  and  she  spontaneously  asked  for  meat.  She  continued  taking  that 
with  relish  and  without  vomiting. 

It  would  be  easy  to  cite  cases  where  drugs  had  effected  the 
same  purpose,  but  I  chose  rather  to  select  an  instance  of  the 
simplest  form  of  restorative  treatment  (namely,  the  direct  re- 
•ment  of  a  deficient  digestive  solvent,  so  as  to  aid  formative 
nutrition'),  in  order  to  direct  the  reader's  thoughts  to  the  true 
theory  of  healing. 

SECTION  X. 
Sea-sickness. 

The  principal  cause  of  the  vomiting  produced  in  those  un- 
use.l  to  it  by  the  motion  of  a  ship  or  carriage,  by  swinging, 
waltzing,  and  the  like,  I  believe  to  be  the  relaxation  of  the 
oesophageal  sphincter  by  the  vibration.  The  body  being  at 
or  rotated  on  itself,  and  the  oesophagus  hanging  somewhat 
loose  in  it,  the  jar  is  strongly  felt,  and  the  involuntary  plexus 
supplying  the.se  muscular  fibres  is  temporarily  paralyzed  by  it. 
In  fact,  a  succession  of  small  strokes  produces  the  same  ell'ect 
in  unaccustomed  nerves  as  one  single  severe  concussion. 

In  both  cases  use  begets  hardness :  those  who  are  exposed  to 
much  knocking  about — wrestlers,  prize-fighters,  huntsmen,  &c. 
— will  get  to  stand  blows  that  would  once  have  stunned  them ; 
au«l  the  jar  and  swinging  of  the  gullet  and  stomach  in  time 
ceases  to  be  followed  by  relaxation  of  the  sphincter.  And  some 
>ns  and  animals,  from  perhaps  a  peculiar  structure  (I  will 
not  call  it  a  malformation)  of  the  parts,  never  experience  sea- 
sickness at  all. 

The  earliest  notice  one  has  of  this  cesophageal  palsy  is  faint- 
«>r  !_ri<Mini'ss,  which  in  a  healthy  and  normally  sensitive 
•  us  always  pivc. •.!(•-:  nokneBS,  whether  arising  from  the  poi- 
soning of  those  nerves  by  an  emetic,  from  Mows  on  the  sto- 
mach or  hca.l.  «>r  from  swinging  motions. 

The  relaxation  of  sphincters  is  always  followed  by  the  expul- 

'  See  "Lectures  chiefly  Clinical,"  lid  Introductory  Lecture,"  Disease  and  Cure." 


236  VOMITING. 

sion  of  the  contents  of  hollow  organs.  Directly  the  anus  is 
opened,  the  abdominal  muscles  act  in  forcing  out  the  feces.  So 
also  with  the  bladder.  And  immediatly  after  the  relaxation  of 
the  oesophageal  fibres,  the  diaphragm  and  its  colleagues  ener- 
getically press  upon  and  empty  the  stomach. 

Even  after  it  is  emptied,  they  continue  to  be  spasmodically 
contracted,  and  the  unhappy  landsman  lies  retching  and  roaring, 
with  nothing  to  throw  up  except  a  little  bile,  which  the  squeez- 
ing has  forced  backwards  through  the  pylorus.  This  is  the 
worst  part  of  the  ailment,  just  as  cramp  of  a  stump  or  of  a  limb 
lying  loose  is  more  painful  than  when  the  muscles  have  some 
resistance  to  act  upon. 

Exposure  to  cold,  either  local  or  general,  makes  sea-sickness 
worse,  by  lowering  the  vitality  of  the  nervous  tissues — partially 
numbing  them,  in  fact.  Artless  landsmen  often  aggravate  their 
misfortunes  by  remaining  on  the  wet,  chilly  deck  in  blustering 
weather ;  the  more  experienced  sufferers  have  avoided  a  great 
deal  by  immediately  going  below  and  getting  warm  and  com- 
fortable before  the  nauseating  stinks  begin  to  be  rife.  Sitting 
with  the  back  leant  against  the  funnel  is  also  of  use,  if  you 
cannot  get  below. 

I  have  never  had  any  valid  experience  of  the  proposition 
made  of  putting  ice  down  the  back  as  a  preventive,  not  having 
travelled  in  any  weather  rough  enough  to  be  a  good  test  since  it 
was  made  public.  I  am  interested  in  the  result,  as  it  would  a 
good  deal  affect  my  view  of  sea-sickness.  Its  having  been  set 
forth  as  a  specific  for  cholera  probably  may  prejudice  the 
public  against  it,  but  should  not  influence  the  calm  judgment 
of  an  experimentalist. 

A  thick  belt  or  Spanish  faja  will  sometimes  keep  off  sea  sick- 
ness, partly  from  the  local  warmth  over  the  epigastrium,  partly 
perhaps  from  the  compression  keeping  the  stomach  and  its 
neighbors  mechanically  steady.  The  benefit  of  lying  flat  on 
the  back  arises  probably  from  a  similar  cause. 

Temporary  stimulants — ammonia,  spirituous  liquors,  chloro- 
form, opium — keep  it  off  for  a  short  time  in  some  individuals  ; 
but  oftener,  I  think,  the  reaction  comes  on  very  soon,  and  their 
last  state  is  worse  than  the  first.  The  beneficial  action  of  sti- 
mulants lasts  longer  if  they  are  combined  with  carbonic  acid, 


VOMITING.  237 

• 

as  in  effervescing  drinks.     Aboard  our  Channel  packets,  "Soda 
and  IV  is  popular :  and  I  have  found  devilled  lobster  and  cham- 
•a  ival   Messing  in  some  rough  weather  off  the  coast  of 
igal :    I  have  also  tried  good  bottled  porter  non  sine  glorid. 
The  powerful  effect   of  mental   emotion   in   bracing  us  up 
-ickness  is  very  remarkable,  and  associates  its  pa- 
thology closely  with  that  of  other  functional  paralyses.     This 
'1  to  be  observed  in  a  striking  manner  in  shipwrecks,  when 
fright  renders  every  soul  alert,  though  before  there  was  any 
danger  they  had  been  exclaiming  that  they  recked  not  what 
:ic  of  them.     Of  that  I  have  no  experience;  but  I  remember 
••ate  with  nausea  in  a  Peninsular  steamer,  when 
the  captain,  knowing  I  was  a  doctor,  begged  me  to  come  and 
<1  to  an  engineer  who  had  got  rolled  into  the  machinery. 
Only  one  finger  was  crushed,  but  the  binding  up  that  and  the 
jcment  of  the  frightened  man  quite  cured  me,  though 
to  an  unapt  surgeon  the  mixture  of  blood, -grease,  and  coal-dust, 
entailed  by  a  machinery  accident,  is  not  agreeable. 

Almost  always,  the  inconveniences  of  sea-sickness  in  a  pre- 
viously healthy  person  cease  with  the  cause:  landing  or  smooth 
r  sets  all  to  rights.     But  sometimes,  as  in  the  following 
case,  there  is  illness  afterwards : — 

CASK  ('('XXIII. — S.  S — ,  a  middle-aged  gentleman  in  fair  health,  accus- 
tomed to  suffer  in  rough  weather,  went  for  a  day's  trip  from  Sorrento  to 
Capri  in  an  open  boat.  There  was  a  good  deal  of  wind  both  going  and 
i  Mining;  but,  contrary  to  his  custom,  he  was  not  sick.  He  remained  well 
that  night ;  but  on  the  morrow  he  was  attacked  with  spasmodic  pain  in  the 
right  side  of  the  epigastrium,  so  that  I  almost  thought  he  must  be  passing  a 
gall-stone  ;  Imt  tin-  bowels  were  opened  naturally  with  formed  feces  of  normal 
coloring.  The  pulse  also  was  unaffected.  He  made  himself  vomit  with  warm 
and  putting  his  finger  down  tin-  throat,  and  brought  up  unaltered  food 
whii-h  he  had  cut  en  the  day  before.  This  vomiting  was  of  no  immediate  use 
in  giving  relief,  but  it  otaKlished  the  diagnosis  of  stomach-ache  rice  gall- 
stones. 

The  pain  spread  over  the  epigastrium,  and  as  it  spread  became  less,  and 
gradually  ceased  the  next  night,  helped  probubly  by  hot  fomentations.  But 
a  certain  soreness  remained  for  a  couple  days  more. 

I  fancy  in  this  case  the  paralysis  ha«l  affected   the  muscular 
fibres  of  the  stomach  more  than  those  of  the  oesophagus,  a; 
a  morbid  condition  was  engendered.  d<  in  a  former  chap- 


238  VOMITING. 

ter  as  spasmodic  pain  of  the  epigastrium,  or  stomach-ache.1  The 
gastric  glands  were  also  paralyzed ;  so  the  food  was  undigested, 
and  not  being  of  a  fermenting  nature,  was  unaltered. 

Sometimes  sea-sickness  passes  into  a  condition  of  chronic 
vomiting. 

CASE  CCXXIV. — Eliza  W — ,  a  young  single  woman,  was  quite  well  till  the 
beginning  of  October,  when  she  came  up  by  a  Hull  steamer  to  London  during 
the  equinoctial  gales.  She  was  violently  sick  on  the  voyage,  and  fancied  she 
twisted  something  inside  her.  On  landing  the  sickness  did  not  cease,  but 
continued  till  her  admission  to  St.  Mary's,  November  14th,  1863.  She  had 
also  got  very  hysterical,  and  said  that  one  day  she  was  quite  paralyzed.  Her 
tongue  was  very  foul,  her  pulse  natural,  her  bowels  constipated,  the  urine 
painful  to  pass.  Her  right  eye  also  became  painful,  and  she  could  not  raise 
the  lid. 

Under  Quinine  and  a  Chloroform  poultice  she  got  much  better  by  the  26th 
of  November.  Then  on  its  being  found  that  the  pupil  of  the  painful  eye  was 
dilated,  and  the  internal  rectus  oculi  paralyzed,  it  was  thought  right  to.  leech 
her  temples. 

On  the  17th  of  December  she  was  attacked  with  vomiting  again,  and  on  the 
possibility  that  the  brain  was  inflamed  the  head  was  shaved  and  blistered,  and 
Iodide  of  Potassium  given.  Apparent  relief  followed,  but  the  patient  got 
very  hysterical.  Finally  the  vomiting  was  stopped  with  Valerian,  but  not  till 
the  end  of  February. 

I  have  never  heard  of  such  a  thing  as  chronic  vomiting  arising 
from  sea-sickness  in  a  man ;  and  I  suspect  that  the  pathological 
interpretation  is  the  passing  of  the  temporary  morbid  condition 
into  that  which  was  described  in  a  previous  part  of  this  chapter 
as  hysterical  vomiting ;  hysteria  being  much  more  common  in 
the  female  sex  than  in  ours. 

I  should  presume  Shower-baths  and  Valerian  would  be  the 
best  cures ;  but  I  have  not  the  authority  of  experience,  as  the 
contingency  is  rare. 

SECTION   X  I. 
Review  of  treatment. 

Ice  or  iced  water  swallowed  is  often  most  useful  in  the  acute 
vomiting  of  fevers  and  of  cholera.  It  stops  the  straining  and 
relieves  the  distress.  I  presume  it  acts  on  the  same  principle 

1  Page  162. 


VOMITIM;.  239 

as  a.  shower-bath,  by  a  revulsive  shock  to  the  nervous  system. 
It  is  also  a  good  astringent  in  bloody  vomiting. 

Rest  in  the  horizontal  posture  and  absence  of  excitement  is  a 
rful  remedy.  It  was  adopted  iu  all  the  cases  quoted  in 
previous  pages. 

Milk  awl  Lime-water  as  a  sole  diet  for  a  few  days  is  an  appli- 
cation of  the  same  principle  of  rest.  It  also  was  a  processus 

Leeches  will  be  seen  to  have  often  stopped  vomiting.  Not 
only  in  gastric  ulcers,  but  in  all  anatomical  lesions,  including 
congestion  of  the  stomach,  their  utility  is  readily  understood. 

J!  randy  j  plain  or  burnt,  in  teaspoonful  doses,  is  a  favorite 

domestic  remedy.     It  relieves  the  faintness  which  accompanies 

vomiting,  and  perhaps  may  be  some  check  in  acute  cases,  such 

a-sickness  (q.  v.).     But  it  is  obviously  unsuited  for  severe 

or  chronic  disease. 

Champagne  and  other  effervescing  stimulants  come  into  the 
same  category.  I  fancy  the  effervescence  diffuses  the  stimu- 
lating ethers  more  quickly  than  when  they  are  taken  flat. 

'  'hloroform  internally  may  also  be  classed  with  them.  Kxter- 
nally  on  the  epigastrium  it  has  not  appeared  to  me  of  certain  use. 
Hydrocyanic  Acid,  when  the  vomiting  arises  not  so  much  from 
a  fault  of  the  stomach  itself  as  from  a  secondary  condition  of 
the  nervous  system,  as  in  pregnancy,  diseased  heart,  abdominal 
tumor,  and  in  pulmonary  consumption. 

But  in  pulmonary  consumption  the  most  powerful  remedy  is 
Cjj'i'i/i/i.  In  gastric  ulcer  also  it  is  invaluable,  and  in  painful 
malignant  tumors.  The  Valerian  and  Shower-baths  are  both 
useful  to  the  same  class  of  cases.  There  are  no  remedies  by 
which  I  have  oftener  stayed  chronic  vomiting;  simply  because 
nervous  debility  is  the  most  usual  cause  of  it. 

Donates  <      '.'        x/a,  Soda,  and  Ammonia,  and  Hyposulphite 

/",  are  especially  indicated  where  there  is  acid  or  alcoholic 

fermentation  <>f  the  vomited  matters,  whether  Surcina  ventri'-nH. 

"Uinl  there  or  not.     They  a--t   palliatively  in  arresting  the 

imposition. 

is  an  uncertain  remedy.    I  confess  I  cannot  find  what 
,itet|   to.      It  loD6  any  -ood  where  the 

other  remedies  have  l>een  in,  :ed. 


240  VOMITING. 

The  administration  of  food  in  cases  of  chronic  vomiting  is  a 
matter  of  much  moment.  We  must  not  let  our  patients  sink 
for  want  of  it.  Even  when  milk  and  Lime-water  does  not  check 
the  retching,  it  is  by  far  the  best  diet ;  and  in  teaspoonfuls  it 
can  almost  always  be  kept  down. 

The  risk  of  being  starved  to  death  from  vomiting  is  not 
purely  hypothetical.  A  young  woman  came  under  my  care  at 
St.  Mary's  in  1857,  who  had  been  deserted  by  her  lover.  She 
had  had  violent  hysteria,  and  an  utter  inability  to  keep  any- 
thing on  her  stomach  for  some  days  already ;  l^ie  pulse  failed, 
and  the  tongue  was  dry  and  brown.  An  attempt  was  made  to 
restore  life  by  means  of  nutritive  enemata,  but  in  vain.  At 
the  post-mortem  examination  every  organ  was  in  a  completely 
normal  state,  and  the  catamenia  were  still  flowing  from  the 
uterus.  She  had  died  of  inanition  only.  The  nutritive  enemata 
were  proved  right,  however  disappointing  the  result  was. 

The  treatment  of  sea-sickness  has  been  discussed  a  page  or 
two  .back. 


241 


CHAPTER  VI. 

FLATULKNCK. 

SECTION  1. — General  Remarks.  SECTION  2. — Knu-tation.  SECTION  3. — Intestinal 
flatulence.  SKCTIO.N  4. — Colouic  datuleiice.  SECTION  5. — Treatment  of  the 
several  sorts. 

SECTION  I. 
General  remarks. 

\VHKX  we  r-pi-ak  of  flatulence  it  must  be  remembered  that 
we  must  not  set  down  all  the  air  contained  in  the  intestinal 
canal  as  morbid :  we  are  not  like  old-fashioned  nurses  to  be 
always  looking  upon  "  wind"  as  an  evil.  A  certain  amount  of 
_en  is  wanted  to  aid  in  the  acidification  which  is  necessary 
to  digestion ;  and  as  this  oxygen  is  to  be  derived  from  the  atmo- 
spheric air,  it  implies  the  presence  of  still  more  nitrogen.  Car- 
bonic acid  is  a  sedative  to  mucous  membranes,  it  is  the  natural 
atmosphere  of  all  internal  parts,  and  they  become  irritated  and 
inflamed  if  they  are  deprived  of  it.  Growth  in  wounds  and 
normal  secretion  in  mucous  membranes  go  on  naturally  only 
when  thus  defended  against  external  influences.  Again,  it  is 
an  important  agent,  indeed  it  may  be  called  a  great  moving 
t,  in  the  digestion  and  circulation  through  the  body  of 
aliments  needful  to  growth. 

There  are  several  elements  of  nutrition,  such,  for  instant- 
the  carbonate  of  lime  and  phosphate  of  lime,  wanted  for  the 
bones  and  nerves,  which  are  insoluble  in  water,  but  are  soluble 
in  water  saturated  with  carbonic  acid.  This  saturation  is 
etVeetetl  by  the  gas  which  remains  in  the  Itowrls  as  a  reservoir 
— as  a  reservoir,  too,  where  a  certain  amount  of  compression  is 

•••(I,  and  the  taking  up  of  the  carbonic  aci<! 
in  natural  springs  or   in  artificial  fixed-air  machines.     Thi.- 
of  the  air  in  the  alimentary  canal  is  really  a  mo>t  important  one. 
16 


242  FLATULENCE. 

For  the  nitrogen  I  do  not  know  how  to  find  a  use  in  the  nu- 
trition or  modification  of  the  tissues.  Some  of  it  is  probably 
taken  up  by  the  blood,  and  excreted  by  the  lungs,  as  in  the 
expired  air  a  considerable  proportion  of  this  gas  is  known  to 
be  found,  forming,  according  to  the  latest  experiments  of  M. 
Barral,  one  per  cent,  of  the  whole,  and  some  may  perhaps  be 
made  into  ammonia.  But  to  that  which  remains  still  in  the 
alimentary  canal  an  employment  may  be  assigned,  humble 
indeed,  yet  contributing  most  exceedingly  to  our  comfort  and 
health.  The  feces  when  they  arrive  at  the  ilio-cascal  valve  are 
almost  fluid,  and  are  so  largely  mixed  with  water  saturated  by 
salts,  that  they  are  of  greater  specific  gravity  than  ordinary 
water,  and  either  sink  in  or  become  mingled  with  it.  If  now 
our  digestive  organs  are  not  performing  their  duty  well,  or  pass 
the  mass  on  too  quickly,  it  comes  into  the  external  air  in  a 
very  similar  state  to  that  above  described.  It  is  a  heavy,  un- 
formed, half-liquid  pulp,  diffusing  itself  inconveniently ;  but  if 
partially  dried  by  the  gas  present,  and  lightened  by  the  admix- 
ture, it  is  much  less  offensive  to  the  senses,  and  easier  retained 
by  the  sphincter  ani. 

It  is  only  then  when  in  excess  that  I  would  speak  of  air  in 
the  alimentary  canal  as  "  flatulence." 

SECTION    II. 

Eructation. 

In  approaching  the  subject  of  eructation  it  must  be  remarked 
.that  gaseous  contents  of  the  hollow  viscera  are  differently  cir- 
cumstanced from  liquids  and  solids ;  their  high  degree  of  ex- 
pansibility by  heat  and  their  low  specific  gravity  give  them  an 
inherent  force  which  urges  them  outwards  without  any  aid  from 
the  muscular  system.  Other  contents  of  the  stomach  require 
the  action  of  the  expiratory  muscles  to  expel  them,  whereas 
gas  warmed  by  the  body  tends  to  rise  through  the  oesophagus 
directly  that  tube  is  relaxed. 

The  essential  condition  is  the  relaxed  and  open  state  of  the 
cardiac  end  of  the  gullet.  The  air,  instead  of  being  retained  by 
the  contraction  of  this  powerful  sphincter,  finds  its  way  upwards 
in  greater  or  less  quantity.  The  passage  of  the  bubble  towards 


FLATULENCE. 


243 


the  mouth,  except  in  completely  paralytic  patients,  causes  a 
reaction,  ami  l>y  the  time  it  gets  to  the  fauces  it  is  compressed 
l>y  tin-  stimulated  muscles,  and  is  suddenly  expelled.  Hence 
the  noise  is  greater  than  is  caused  by  the  mere  bubbling  of  air 
up  the  throat,  such  as  you  produce  in  moving  a  dead  body,  or 
an  apoplectic  patient.  There  is  a  combination  of  relaxation 
with  spasm,  the  former  taking  the  initiative. 

The  relaxation  is  by  no  means  so  complete  as  in  vomiting. 
The  bubble  of  air  is  allowed  to  pass,  and  then  the  oesophagus 
acts  again  immediately. 

The  following  table  exhibits  a  comparison  of  several  analyses 
of  the  air  found  in  different  parts  of  the  healthy  human  intes- 
tinal canal : — 


I.i  STOMACH. 
Volume  perci-nt. 

IN  IT.IA. 
Volume  per  cent. 

IK  Cm.nx. 
Volume  per  cent. 

Carbonic  acid 

(            14       (Ckevrrxl)  1 
(  25.2-27  8     (Clifvillof)  ) 

24.39  (Chevrent) 

(43.5  -70       (ChevrtuD 
\  23.11-93       (CheviUot) 

(11        (Clirvrr.nl)  \   0          (Chevreiil) 

(         0             (Ch> 

u*ygen  \    8.2-13.0    (CheviUot)  f  2-3      (CheviUot) 

\          2-3         (Che  i:  ill  nt) 

Nitrogen  

(            71.45  (Ch't-rnil)  [ 
\  66.8-59.2    (C/trvillot)  J 

20.08  (Chevreut) 

\  18.40-51.  03  (CV/r 
(  95.2  -90.0    (CheviUot) 

(                Z.bb(Chrvrrnl)  \ 
»>'llr"8«  \    »  trace      (Ck~iU«)\ 

55.53  (Chevreul) 

Sulphuretted 

* 

hydr 

1.0             (Marehantf) 

C:irliur«'tt«'d 

(    5.47-11.6    (Cherrrnl) 

hydrogen  ... 

\  28.0                (Cluvillot) 

With  regard  to  the  gaseous  contents  of  the  stomach,  as  exhi- 
bited above,  it  may  be  observed  readily  that  more  than  four- 
tit'ths  is  atmospheric  air,  and  the  rest  is  carbonic  acid  in  much 
proportion  than  in  the  breath  which  is  passing  out  of  the 
trachea  by  expiration,  and  which  constitutes  the  air  of  the 
mouth  and  saliva.  This  fact  -ivcs  us  a  strong  hint  of  its  source. 
It  is  evidently  in  a  healthy  person  swallowed  with  the  food  and 
frothy  saliva  in  such  quantities  as  to  fill  the  organ  up  to  the 
points  of  normal  distension. 

I  think  too  in  the  majority  of  eases  also,  where  the  collection 
and  evacuation  of  air  from  the  stomach  is  so  abundant  and  in- 
convenient as  to  be  considered  a  disease,  that  we  may  trace  out 
the  same  source  of  it.  Observe  paroxysms  of  sobbing,  globus 


24-i  FLATULENCE. 

hystericus,  epilepsy,  or  chorea,  and  you  will  see  great  quantities 
gulped  down.  Watch  those  who  are  suffering  from  heartburn, 
and  you  will  see  them  swallow  air  or  frothy  saliva,  as  if  to 
relieve  their  discomfort. 

Other  persons  have  a  careless,  vulgar  way  of  eating  with  the 
mouth  open,  which  makes  them  swallow  a  quantity  of  air. 
Others  have  a  trick  of  half- unconsciously  gulping  it  down;  and 
a  very  silly  aspect  it  gives  them,  something  like  that  of  a  gob- 
bling turkey-cock :  you  may  notice  them  bridling  up  and  tucking 
in  their  chins.  I  fancy  the  feeling  leading  them  to  do  it  must 
be  something  like  that  which  makes  horses  crib-bite — a  sort  of 
modified  heartburn ;  but  it  is  more  trick  than  anything  else. 

In  health  all  the  air  swallowed  is  readily  absorbed.  There 
are  many  individuals  who  never  pass  It  away,  upwards  or  down- 
wards, for  months  together ;  indeed,  so  long  as  the  perfect  type 
of  health  is  preserved,  it  may  be  said  to  be  never  excreted. 
After  a  meal  their  abdomen  is  as  usual  distended  with  air,  but 
it  is  all  removed  by  absorption  before  the  next. 

In  many  morbid  conditions  this  is  not  done.  When  the 
vitality  is  lowered,  probably  the  function  most  generally  inter- 
fered with  is  absorption.  The  air  collects,  is  swelled  by  heat, 
and  expelled,  although  in  no  excessive  quantity.  Should  the 
oesophagus  be  easily  relaxed,  there  is  eructation ;  should  it  be 
contracted,  there  is  intestinal  flatulence. 

So  far,  the  bulk  of  air  swallowed  has  been  supposed  to  be 
increased  only  by  heat  and  expansion.  But  in  some  cases  it  is 
further  augmented  by  gases  disengaged  from  decomposed  food. 
The  occurrence  of  alcoholic  fermentation  in  the  digestive  canal 
is  proved  by  instances  of  vomiting,  in  which  the  matters  ejected 
are  visibly  undergoing  this  chemical  change.  They  are  frothy 
with  carbonic  acid  like  yeasty  beer,  and  they  continue  frothing 
up  even  when  left  to  stand  after  ejection.  (See  CASES  CXCII, 
CXCIII,  CXCIV,  CXCV.)  We  can  easily  imagine  what  a  dis- 
turbance in  the  stomach  this  must  make,  and  are  not  surprised 
at  the  ejection  of  such  a  turbulent  guest. 

Fortunately  this  spread  of  alcoholic  fermentation  through  the 
saccharine  contents  of  the  stomach  is  rare.  Its  features  are  s6 
marked,  and  the  discomfort  it  causes  so  great,  that  we  should 
be  sure  to  hear  more  about  it  were  it  common.  The  fact  is,  that 


FLATfLKXCE.  245 

even  where  it  beting  and  gives  rise  to  the  disengagement  of 
some  carbonic  acid,  it  is  rapidly  stopped  by  the  conversion  of 
the  sugar  into  lactic  acid,  a  kind  of  fermentation  more  congenial 
to  tin.'  temperature  of  the  body.  So  that  the  "  acidity,"  which 
in  a  former  chapter  has  been  spoken  about  as  an  evil,  is  a 
defence  n^ainst  one  much  more  serious. 

It  will  be  seen  from  what  has  gone  before  that  I  class  the 
>  of  eructation  which  come  before  us  into  three  groups : — 

1.  Those  where  there  is  simply  a  relaxed  oesophagus,  and  the 
air,  though  only  in  natural  quantity,  breaks  upwards. 

2.  Where  tjiere  is  an  excess  of  atmospheric  air  swallowed 
from  habit,   or   in    the   attempt  to   relieve  an  uncomfortable 
ferling  arising  either  from  the  stomach  itself,  or  some  of  the 
neighboring  viscera,  as  the  heart  for  instance. 

3.  Where  carbonic  acid  is  formed  by  alcoholic  fermentation, 
unchecked  by  acetification. 

This  grouping  has  a  bearing  mainly  on  treatment,  and  a 
reference  to  the  cases  recorded  will  show  readily  to  which  class 
they  belong. 

In  the  majority  of  patients  it  is  the  escape  of  air  from  the 

stomach  that  is  complained  of;  but  sometimes  a  retention  of  it 

-  place  with  considerable  inconvenience.  It  may  (especially 

in  elderly  persons  and  cardiac  patients)  collect  in  such  quanti- 

M  a  paralysis  of  the  muscular  coat  of  the  stomach, 

and  put  them  in  considerable  danger  by  impeding  the  action  of 

the  heart  and  diaphragm,  and  causing  deadly  faintness.     I  use 

the  epithet  "  deadly"  from  recollection  of  the  following  case. 

CASK  OCX XV. — When  I  was  physician  to  the  Chelsea  Dispensary,  I  saw 
occasionally  for  shortness  of  breath  a  fat  single  woman  of  from  forty-five  to 
fifty  years  of  a#e.  She  complained  <>f  eructations,  and  of  the  upper  part  of 
the  belly  beiny  swollen  with  wind,  which  I  attributed  to  over-fat  diet  and 
slupjrish  habits.  One  day  they  sent  for  me  suddenly  to  say  she  was  d\  n_'. 
and  when  I  pot  to  the  house  she  was  dead.  On  a  post-mortem  examination, 
the  heart  was  indeed  slightly  dilated  ami  perhaps  pale,  but  appeared  ni^re 
e«|iial  to  work  than  the  majority  of  hearts  we  see.  But  it  was  really  quite 
difficult  to  tret  it  out  of  the  chest,  so  pressi-d-np  was  tin-  diaphragm  by  the 
stomach  enormously  distended  by  its  gaseous  contents,  devoid  of  smell,  and 
certainly  not.  therefore,  the  product  of  post-mortal  decomposition.  This  dis- 
•  •u  Deemed  to  have  !•  I  !  death. 


2-i6  FLATULENCE. 

More  generally  matters  do  not  go  quite  so  far  as  that. 

CASE  CCXXVI. — Mr.  James  L — ,  a  hale-looking  man  of  63,  came  for  my 
opinion  at  the  beginning  of  March,  1867,  about  excessive  dyspnoea  by  day  and 
orthopnoea  by  night,  with  which  he  suffered.  Sponges  and  other  instruments 
had  been  put  down  the  throat  (?  into  the  larynx)  without  any  benefit.  On 
examination  of  the  pulse,  this  want  of  success  was  readily  explained  by  an 
excessive  irregularity  and  intermittence.  The  heart  was  also  irregular,  but 
not  so  intermittent  as  the  pulse.  The  sounds  were  normal,  but  diffused. 

As  the  urine  was  also  albuminous,  I  gave  an  unfavorable  prognosis. 

But,  to  my  surprise,  a  few  days'  dosing  with  Strychnine,  Digitalis,  and  Iron 
reduced  the  action  of  the  heart  to  regularity,  and  so  far  relieved  the  dyspnoea, 
that  the  patient  was  able  to  take  exercise  with  ease.  He  said  he  had  broken 
off  wind  from  the  stomach  in  several  great  bursts,  and  that  new  relief  had 
followed  each  explosion.  It  was  necessary  to  modify  jny  prognosis.  In  three 
weeks'  time  he  was  really  as  hearty  and  well  as  any  one  can  be  at  sixty-three. 

This  sudden  relief  of  the  stomach  by  paroxysmal  explosions 
is  exemplified  in  a  former  case,  also  an  elderly  man,  where 
the  cure  of  a  long-continued  waterbrash  followed  thereon 
(CASE  CXXY). 

The  pathology  of  such  cases  seems  to  be  that  there  is  a 
paralysis  of  the  gastric  walls ;  air  is  drawn  into  the  dilating 
organ,  swells  from  heat,  further  dilates  it  and  increases  the 
paralysis,  till  such  time  as  the  sudden  contraction  of  the  circular 
fibres  is  brought  about  by  nature  or  art,  and  then  all  is  expelled 
at  once,  sounding  the  triumphal  note  of  cure  rather  than  being 
its  cause. 

It  is,  however,  in  the  flatulence  of  dyspeptic  hysteria  that 
the  explosions  are  most  remarkable ;  they  occur  again  and 
again,  and  are  graphically  described  in  CASE  XCVI  as  "  roaring 
eructations."  When  they  are  repeated  so  quickly  as  this,  the 
air  can  of  course  be  collected  only  by  being  swallowed. 

The  pathological  etiology  of  eructating  flatulence  is  to  be 
sought  in  causes  which  lower  the  local  vital  force  of  the  gastric 
involuntary  nerves,  and  so  make  the  muscular  action  inter- 
mittent and  irregular.  Such,  for  example,  is  starvation  in  CASES 
I,  II,  CX,  &c.,  the  pressure  of  the  last  in  the  shoemaker  CASE 
LXXII,  excess  of  tea-drinking  in  CASE  XCVI,  extraordinary 
fatigue  in  CASES  IX,  XIII,  &c. 


FLATULENCE.  247 

SECTION   III. 
Intestinal  flatidence. 

A  reference  to  the  short  table  given  in  the  second  section 
will  show  that  in  the  gaseous  contents  of  the  ilia  there  is  an 
increase  in  the  quantity  of  carbonic  acid  relatively  to  the 
:en,  or,  if  we  like  so  to  regard  it,  a  decrease  of  the  latter. 
At  the  same  time  hydrogen,  scarcely  present  in  the  stomach, 
forms  a  good  half  of  their  bulk.  This  hydrogen  cannot  be 
swallowed  air,  and  is  not  likely  to  be  excreted  from  the  blood ; 
i'»>r  we  do  not  know  of  any  gas  besides  carbonic  acid  owing  its 
origin  to  anv  important  amount  from  the  circulating  fluid.  It 
must,  I  conceive,  arise  from  the  chemical  changes  going  on  in 
the  remains  of  the  food.  I  do  not  think  any  large  quantity  of 
air  passes  the  pylorus,  but  that  the  bulk  of  the  gas  in  the  ilia 
comes  from  decomposition  of  their  contents. 

In  a  state  of  health  this  gas  is  reabsorbed  nearly  as  soon  as 
formed,  so  that  only  for  a  short  time  after  meals  is  the  abdomen 
I'UtVy ;  but,  as  I  explained  before,  lowered  vitality  promotes  the 
collection  of  air  by  arresting  absorption. 

Lowered  vitality  also  increases  the  extent  of  decomposition, 
by  diminishing  the  flow  of  bile.  The  action  of  this  secretion 
on  food  is  exhibited  in  the  experiments  made  by  MM.  Bidder 
and  Schmidt  upon  dogs.1  They  found  that  when  the  flow  of 
bile  into  the  intestine  was  cut  off  by  tying  the  ductus  communis 
choledochus,  rapid  chemical  changes  took  place  in  all  sorts  of 
food.  When  the  animals  were  fed  on  flesh,  the  feces  smelt  like 
carrion ;  there  was  a  continual  rumbling  of  the  abdomen  and 
an  evacuation  of  fetid  air.  When  they  were  fed  on  bread  only, 
odor!  :  id  sour  feces  were  passed.  No  further  injury 

iid  emaciation  and  weakness  followed  during  the  eiirlit 
wei-ks  of  the  experiments.  From  them  we  have  a  right  to  infer 
that  one  of  the  chief  functions  of  the  bile  is  to  act  on  albuminous 
matters  as  an  antiseptic,  preventing  their  putrid  decomposition, 
and  preserving  them  safely  to  lie  exposed  as  much  as  possible 
to  the  absorbents  of  the  alimentary  canal :  and  that  at  the  same 
time  the  •  .  ••  formation  of  acid  from  vegetables  is  chr- 

1  Bidder  and  Schmidt,  "  Die  Verdauuiigasilfte,"  p.  230. 


248  FLATULENCE. 

so  that  it  may  proceed  gradually  and  as  required  by  the  digestive 
process,  In  fact,  the  condition  produced  in  dogs  by  mechani- 
cally stopping  the  functioning  of  the  liver  answers  exactly  to 
the  intestinal  flatulence  of  dyspeptics  in  our  species. 

It  may  be  observed  that  it  is  a  long  time  after  a  meal,  in  fact 
just  before  the  next  meal,  that  the  bile  is  normally  poured  in 
greatest  quantities  into  the  duodenum:  in  dogs  in  twelve  or 
fourteen  hours,  in  men  about  four  or  five.  Now  this  is  just  the 
period  when  it  is  most  wanted  to  prevent  decay,  and  just  the 
period  when  intestinal  flatulence  from  its  deficiency  most 
usually  occurs. 

Excess  of  gas  in  the  small  intestines  is  the  most  troublesome 
sort  of  wind.  Should  it  escape  upwards  through  the  pylorus 
into  the  stomach,  it  is  apt  to  cause  vomiting ;  or  sometimes  it 
constitutes  a  most  nauseous  eructation  of  sulphuretted  hydro- 
gen. Luckily  this  is  rare.  There  seems  too  to  be  some  diffi- 
culty about  the  passage  of  air  downwards  through  the  ilio-caecal 
valve.  Hence  intestinal  flatus  often  rolls  about  in  the  abdomen 
from  the  changes  in  position  which  the  motion  outwards  of  the 
alimentary  masses  involve,  and  causes  the  well-known  and  dis- 
tressing grumblings  of  the  belly  or  "  borborygmi,"  aptly  called 
in  English  a  "  glug-glug."  The  abdomen  will  be  distended  for 
several  days  with  it,  without  its  being  expelled  or  absorbed 

Its  escape  into  the  colon,  even  without  making  its  way  out  of 
the  body,  gives  immediate  relief  (see  CASE  XX,  page  46). 

There  is  very  often  considerable  pain  in  one  side  or  the  other, 
most  generally  the  right  hypochondrium.  The  patients,  espe- 
cially if  they  are  old  Indians,  will  say  they  have  got  "  liver." 
Where  there  is  most  pain  in  the  side  there  is  least  grumbling 
of  the  belly :  so  I  suppose  it  must  arise  from  the  long-continued 
immovable  distension  of  one  part  of  the  gut. 

Flatus  in  the  intestines  is  troublesome  during  the  day,  from 
the  tumidity  of  the  abdomen,  and  noise  on  motion,  and  pain  in 
the  sides ;  but  when  it  comes  at  night  it  causes  still  more  incon- 
venience by  preventing  sleep.  It  is  hard  to  explain  why  this 
should  be ;  in  many  cases  there  is  not  enough  pain  or  discom- 
fort to  account  for  it,  yet  a  complete  wakefulness  and  apparent  • 
want  of  wish  for  sleep  prevail.  It  is  to  be  remarked,  also,  that 
this  insomnia  is  in  many  instances  made  worse  by  Opium. 


FLATULENCE.  249 

Sometimes  the  patient  will  go  to  sleep  easily  and  naturally  on 
first  lying  down,  and  will  then  wake  up  in  an  hour  or  two, 
finding  the  abdomen  tumid  and  uncomfortable,  and  will  remain 
entirely  without  rest  for  the  remainder  of  the  night;  or  if  there 
be  a  lapse  into  unconsciousness  for  a  few  minutes,  the  uneasy 
sleep  seems  rather  to  aggravate  than  to  relieve  the  feverish 

i ess,  and  to  cause  headache. 

During  this  unnatural  repose  men  are  often  annoyed  with 
disgusting  erotic  dreams' and  abnormally  frequent  seminal 
emissions.  I  have  never  ascertained  whether  any  analogous 
t  is  produced  in  the  female  sex.  The  line  of  causation 
cannot  at  present  be  traced,  the  bowels  and  the  generative 
organs  appearing  to  have  so  little  to  do  with  one  another. 

The  persons  most  liable  to  this  troublesome  affection  are 
women,  especially  those  of  weak  muscular  fibre,  anaemic  dia- 
t  lies  is,  and  a  tendency  to  form  fat.  We  may  attribute  it,  under 
•  circumstances,  to  a  naturally  sluggish  portal  circulation, 
which  does  not  so  quickly  absorb  the  contained  air  as  a  freer 
current  through  the  bloodvessels  would  do. 

CASK  ('('XXV II. — Mrs.  R — ,  aged  about  40,  has  been  from  time  to  time  a 
patient  of  mine  during  the  last  six  years,  on  account  of  increasing  corpulence, 
inability  to  walk  without  violent  perspirations  or  exhaustion,  palpitation  of 
heart  ami  ana-mic  irregularity  of  catumcnia.  Last  week  (March,  1867)  she 
caim-  to  town  in  considerable  pain  all  over  the  abdomen,  starting  from  under 
the  right  ribs.  The  abdomen  was  very  large,  and  I  thought  at  first  she  had 
.•••ttin.tr  fat  again  :  but  she  denied  having  increased  in  corpulence  as  to 
the  other  parts  of  her  body  lately.  It  was  very  tympanitic  on  percussion. 

This  swelling  of  the  abdomen  made  her  very  short  of  breath,  and  at  night 
she  could  hardly  lie  down,  and  was  frequently  woke  up  by  discomfort. 

Tin-  bowels  were  fidgety  in  their  action;  sometimes  confined,  but  more 
usually  open  in  small  quantities  several  times  daily.  The  feces  were  semi- 
fluid, lijjht-colored.  and  very  offensive.  Flatus  was  not  now  passed  per  anum 
with  them,  thoiisrh  that  escape  was  habitual  in  ordinary  health. 

The  appetite  was  deficient,  the  tongue  coated.  The  catamenia  had  been 
the  last  few  period.-  rather  more  profuse  than  ordinary. 

1  am  giving  her  Valerian  and  Strychnine  to  strengthen  tho  peristaltic 
action,  and  a  small  dose  nightly  of  Aloe's  to  augment  temporarily  the  excre- 
tion of  bile. 

Remark  here  that  when  she  wa>  in  health  the  tras  escaped  by 
the  usual  passage,  but  that  in  illness  it  was  retained  :  ami  was 


250  FLATULENCE. 

retained  immovably,  as  shown  by  the  pain  in  the  right  side. 
The  feces  are  just  those  of  the  dogs  experimented  upon  by  MM. 
Bidder  and  Schmidt.  The  sulphuretted  hydrogen  and  hydro- 
sulphate  of  ammonia  formed  by  the  decomposition  of  animal 
viands  unguarded  by  bile  seem  to  be  purgative  poisons,  and 
where  they  are  found  the  stools  are  semi-liquid. 

In  looking  over  the  foregoing  pages  for  chronic  conditions 
in  which  intestinal  flatus  was  conspicuous,  I  find  Bright's  dis- 
ease, CASE  IV;  Old  age,  CASE  XII;  Eachitis,  CASE  XLIV. 
Immediate  causes  mentioned  are — Anxiety  and  application  of 
mind,  CASES  XIV,  XV,  LXXVIII ;  Loss  of  blood,  CASE  XLIX ; 
Over-eating,  CASES  LX,  LXII,  LXIV;  Irregularity  and  other 
bad  habits  of  meals,  CASES  LXXVI,  LXXIX. 

In  many  other  similar  cases  recorded  in  Chapters  II  and  III, 
where  flatulence  is  spoken  of,  the  subject  of  the  present  section 
is  intended. 

Disease  of  the  stomach  seems  as  a  rule  to  exclude  intestinal 
flatus.  Thus  it  may  be  observed  to  be  conspicuous  by  its  ab- 
sence in  the  Chapters  on  "Abdominal  pains"  and  "  Vomiting." 

SECTION  IV. 
Colonic  flatulence. 

Flatulence  in  the  colon  may  be  distinguished  from  that  in 
the  small  intestines  by  its  position  ascertained  by  percussion, 
by  the  absence  of  rumbling  (except  a  little  bubbling  through 
the  ilio-caecal  valve  just  before  it  escapes),  and  by  its  passing 
out  freely  per  anum. 

A  reference  to  the  table  in  page  243  will  show  in  the  normal 
gaseous  contents  of  this  part  of  the  bowels  the  presence  of  sul- 
phuretted and  carburetted  hydrogen.  But  in  health  the  quan- 
tity of  the  former  is  not  enough  to  overcome  the  prevailing 
odor  of  feces.  In  some  cases  of  disease  the  sulphuretted  hy- 
drogen, arising  from  the  decomposition  of  albuminous  matter 
unchecked  by  the  normal  flow  of  bile,  is  in  excess,  and  may 
then  be  readily  detected.  In  other  cases  scentless  carburetted 
hydrogen  and  carbonic  acid  seem  the  prevailing  gases.  In  the 
former  there  is  albuminous,  in  the  other  starchy  dyspepsia. 


FLATULENCE.  251 

When  much  sulphuretted  hydrogen  is  present,  there  may  be 
a  diarrhoea  of  feculent  matter;  but  colonic  flatulence  is  more 
commonly  accompanied  by  costiveness  and  constipation.  The 
colon  does  not  appear  to  be  so  sensitive  to  poisons  as  the  ilia. 

I-  is  intestinal  wind  that  is  generally  complained  of  by  pa- 
tients who  are  bad  enough  to  be  driven  to  a  doctor,  and  is  that 
which  is  generally  alluded  to  as  "llatulence"  hi  the  cases  in  an 
earlier  part  of  the  volume. 

onir  llatulence  is  not  nearly  so  distressing  as  intestinal,  and 
not  cause  so  much  wakefulness  or  other  nervous  disorders. 

SECTION  V. 

Treatment  of  the  several  sorts  of  flatulence. 

/         "'ion  may  in  some  cases  be  stayed  by  solely  a  direct 
restorative  treatment  of  the  cause.    The  defective  digestion  may 
jtlaced  by  artificial  gastric  juice.     For  example — 

X  X  VIII.— James  B— ,  a  laborer  of  50,  was  taken  in  at  Pt.  Mary's 

April  20th,  1856,  for  a  catarrhal  cough  of  ten  weeks'  standing,  with  some 

(••. Miration  of  the  lower  part  of  the  lungs.     The  object  of  admitting  him  was 

liis  cough  the  benefit  of  the  regulated  temperature  of  the  ward,  with 

\u  cough  medicines  were  considered  needful.     lUit  he  complained  that 

after  meals  he  had  throughout  his  illness  been  troubled  with  wind  breaking 

up  from  the  stomach.     It  was  tasteless  and  inodorous. 

Fifteen  grains  of  I'.oiidault's  lYpsine  Powder  was  administered  daily  with 
his  dinner.  On  the  l!5th  the  flatulence  was  relieved,  and  he  went  out  well  on 
the  1st  of  May. 

Where  excess  of  air  is  swallowed  from  abnormal  sensibility 
and  breaks  up  in  eructations,  Valerian  and  Ammonia  are  useful, 
but  above  all  shower-baths.  I  do  not  know  any  disease  in 
which  their  value  is  more  marked.  The  more  the  patients  can 
bear  of  them  the  better,  and  the  sooner  they  can  get  educated 
i"  take  them  in  full  quantity  and  cold  the  better.  First  let 
tin-in  In-  administered  tepid,  then  with  the  shower  cold  and  the 
foot-pan  warmed  with  hot  wat«-r.  then  make  them  all  cold,  and 
each  day  let  the  ijnaiitity  of  water  be  gradually  increased  till 
the  full  extent  that  the  bath  will  hold  be  arrived  at. 

Kxamples  of  this  principle  of  treatment  are  given  in  (.' 
CXOTII,  CO,  CClll,  00V. 


« 

252  FLATULENCE. 

When  the  eructations  depend  on  the  formation  of  carbonic 
acid  by  alcoholic  fermentation,  the  Hyposulphite  of  Soda  is  in- 
dicated. See  Case  CXCV. 

Eructation  from  this  cause  is  rare  without  vomiting. 

The  aim  of  the  treatment  mentioned  is  to  prevent  decomposi- 
tion of  organic  matters.  In  the  laboratory  we  find  that  nothing 
is  so  powerful  in  this  respect  as  Sulphurous  Acid ;  and  accord- 
ingly it  is  used  in  various  processes  of  the  arts  for  the  purpose. 
Sulphur  is  burnt  by  wine-growers  in  casks  used  a  second  time 
to  arrest  the  fermentation  which  is  apt  to  be  going  on  in  the 
liquids  soaked  up  by  the  cracks  or  porous  parts  of  the  staves, 
and  the  acid  vapors  effectually  do  their  duty.  The  agents  of 
the  Board  of  Health  find  no  disinfectant  for  sewers  so  quick 
and  certain  in  its  action  as  Macdougal's,  the  chief  ingredient  in 
which  is  Sulphite  of  Lime.  Muscular  tissue  may  be  prepared 
on  the  same  principle,  and  keeps  as  well  as  when  salted  or 
dried ;  and  we  may  test  even  on  such  a  delicate  substance  as 
yelk  of  egg  how  fresh  it  keeps  with  sulphite  of  salt.  The  same 
effect  is  produced  by  taking  as  a  medicine  Hyposulphite  of  Soda ; 
the  fermentation  of  the  contents  of  the  stomach  is  arrested,  and 
the  evil  effects  of  that  fermentation  prevented. 

But  it  must  be  remembered  that  the  digestion  of  the  meat  is 
also  checked.  Dried,  salted,  or  otherwise  chemically  prepared 
victuals  are  not  so  soluble  as  fresh ;  indeed,  if  completely  dry 
they  are  not  soluble  at  all ;  and  to  continue  the  Hyposulphite  of 
Soda  long  would  put  the  patient  into  the  condition  of  a  sailor 
reduced  to  salt  junk. 

A  safer,  but  equally  powerful  arrester  of  chemical  changes  is 
Charcoal.  When  soup  has  begun  to  turn  in  hot  weather, 
economical  cooks  heat  it  up  with  a  little  bag  of  Charcoal  in  it, 
and  it  becomes  quite  sweet.  This  shows  that  the  carbon  does 
something  more  than  merely  condense  the  gases  formed.  The 
same  agent  will  accomplish  the  same  result  in  the  alimentary 
canal.  I  myself  have  used  it  truly  only  in  cases  where  decom- 
position producing  flatulence  occurs  in  the  intestines ;  but  I 
should  not  hesitate  to  give  it  in  gastric  fermentation  also,  if 
Hyposulphite  of  Soda  chanced  to  disagree  or  had  failed  in  its' 
effect. 


FLATULENCE.  253 

The  general  treatment  of  indigestion  by  Quinine  and  Strych- 
nine, as  several  times  here  advocated,  is  specially  indicated  in 
eructation,  inasmuch  as  the  most  failing  function  is  that  of  the 
contractile  fibres  of  the  oesophagus  and  stomach,  and  to  these 
our  remedy  first  arrives.  An  example  of  their  rapid  action 
may  be  read  in  CASE  CXXV. 

As  stated  in  the  last  leaf  but  one,  intestinal  flatulence  exhibits 
best  the  power  of  charcoal,  because  the  air  has  more  difficulty 
in  being  got  rid  of  without  some  such  help,  and  the  air  formed 
by  decomposition  is  peculiarly  copious  and  troublesome. 

In  ordinary  cases  there  are  usually  joined  several  other  reme- 
dies to  the  Charcoal,  such  as  Quinine  and  Strychnine  (for  the 
•n  given  a  few  sentences  back),  and  Soda  and  Valerian,  or 
(ialbanum,  or  Assafostida,  so  that  the  action  of  the  Carbon  is 
complicated.  I  have  therefore  selected  for  the  nonce,  to  exhibit 
necial  and  independent  action,  a  rather  out-of-the-way  in- 
stance, in  which  the  collection  of  air  took  place  in  consequence 
of  a  mechanical  lesion  entirely  preventing  its  passage  (for  the 
small  exit  must  have  been  always  blocked  up  by  feces),  and  in 
which  the  only  antiseptic  and  absorbent  used  was  Charcoal. 

CASK  CCXXIX. — Elizabeth  C — ,  aged  63,  was  admitted  to  St  Mary's  under 
my  c;irv  J;um:iry  lf>th,  l>r>7.  Though  thin  and  not  muscular,  she  had  always 
i  hard-working  active  woman,  and  had  borne  thirteen  children,  of  whom 
but  two  were  dead,  one  of  phthisis  and  one  of  scarlatina.  She  herself  could 
recollect  no  illness  except  scarlatina  and  child-bearing,  till  five  months  agone, 
when  she  noticed  that  the  left  side  of  the  abdomen  was  often  swelled,  and 
that  the  swelling  was  relieved  by  a  copious  explosion  of  wind  by  the  anus. 
A  like  swelling  she  also  perceived  some  time  afterwards  on  the  right 
since  which  she  had  not  so  often  been  relieved  by  the  passage  of  wind.  She 
lr.nl  also  frequently  a  feeling  of  numbness  and  iiivoluiitary  twitches  in  the 
legs. 

She  l:iy  on  her  back,  when  I  visited  her,  with  the  abdomen  raised  up  by  a 
great  collection  of  air.  It  measured  thirty-eight  inches  in  circumference.  N<> 
solid  tumor  could  be  felt.  The  bowels  were  very  coii.-tipated,  and  under  the 
influence  of  purgatives  only  a  little  fluid  feculent  nutter,  but  no  air,  was 


An  attempt  was  made  to  relieve  her  by  passim:  :i  tube  up  the  rectum,  but 
no  air  was  let  off  even  thus.  A  many-tailed  bandage  was  bound  tightly  round 
the  belly,  but  no  diminution  in  six.e  followed.  Turpentine,  too,  was  adminis- 
tered, luit  it  was  frit/ 

On  the  'JlM  1  ordered  a  drachm  of  Charcoal    to  be  gi\  :her  hour, 


254  FLATULENCE. 

the  bandage  being  still  kept  on.  On  the  25th  she  was  much  better,  the  dis- 
tension being  much  less.  On  the  27th  she  had  increased  somewhat,  so  I 
added  l-12th  of  a  grain  of  Strychnia  to  the  powders  on  those  occasions  daily. 
From  that  time  we  continued  to  find  the  abdomen  softer,  the  patient  lost  her 
pain  and  gained  strength,  but  with  occasional  relapses  of  distension. 

On  the  20th  of  February  she  was  able  to  get  up.  Her  bowels  were  regu- 
larly opened  by  a  simple  enema,  with  sometimes  a  few  drops  of  Cajeput  Oil. 
Her  tongue  was  clean,  and  the  general  health  was  good,  and  in  the  beginning 
of  March  she  was  actually  assisting  in  the  work  of  the  ward.  She  herself 
pronounced  that  she  was  well  enough  to  return  home,  and  arranged  to  do  so 
on  the  23d.  However,  early  in  the  morning  of  that  very  day  she  suddenly 
died,  the  only  warning  of  her  being  worse  having  been  a  certain  relapse  of 
distension  on  the  21st. 

On  post-mortem  examination  there  was  found  in  the  lower  part  of  the 
ileum,  on  the  right  side,  an  occlusion,  as  of  a  hard  contracted  scar,  without 
any  peritoneal  adhesions.  The  occlusion,  at  first  view,  seemed  quite  com- 
plete ;  but  on  further  manipulation  a  dissecting  probe  was  passed  through  it 
by  a  winding  passage.  Above  this  the  intestines  were  greatly  distended  with 
air  and  semi-fluid  black  feces.  But  what  surprised  us  was  the  entire  absence 
of  fetid  odor  in  all  this  matter  so  long  retained.  It  was  not  nearly  so  un- 
pleasant as  that  found  in  a  corpse  accidentally  killed  in  full  health. 

The  last  observation  is  my  reason  for  my  citing  here  this 
somewhat  long  and  painful  case.  If  the  Charcoal  can  so  act 
where  a  mechanical  impediment  confines  the  gases  to  the  in- 
testines as  by  a  ligature,  and  half  kills  them  by  strangulation, 
it  must  be  still  more  powerful  when  it  is  aided  by  the  vital  force 
still  remaining  only  slightly  arrested,  as  in  ordinary  cases. 
For,  in  truth,  people  may  be  very  flatulent  without  being  very 
ill. 

Charcoal  being  tasteless  is  not  disagreeable  to  take  when  you 
have  got  over  the  grittiness  in  the  mouth.  The  only  other 
objection  I  have  had  raised  is  its  color.  A  wit  of  the  Midland 
Circuit  told  me  I  was  turning  his  "  colon"  into  a  "  coalhole." 

It  is  scarcely  needful  to  say  that  easily  fermentable  articles  of 
diet  must  be  for  some  time  shunned,  if  the  patient  would  avoid 
a  recurrence  of  the  complaint. 

Great  advantage  arises  in  intestinal  flatulence  from  the  use 
of  such  expedients  as  restore  the  flow  of  bile  in  full  quantity  • 
a  chief  business  of  that  secretion  being  the  prevention  of 
chemical  decomposition  in  organic  matters. 

Temporary  use  may  be  made  of  drugs  for  this  purpose. 


FLATULENCE.  255 

Tin'  Salts  of  Mercury  (viz.,  the  gray  oxide  and  calomel)  were 
found  in  some  experiments  made  by  Dr.  Handfield  Jones  on 
animals  to  increase  the  production  of  yellow  matter  in  the 
hepatic  cells.  But  when  this  metal  was  given  there  was  also 
great  sanguineous  congestion  of  the  liver,  which,  on  the  con- 
trary, was  pale  alter  an  administration  of  drugs  which  had  not 
augmented  the  yellow  matter. 

M- :,••''!•>  •  </'  M>iinjanese  and  Cokhicum  had  also  the  like  effect. 

'fie  acid  during  life  caused  a  flow  of  bile  per  anum 
in  a  cat;  but  there  was  no  excess  of  yellow  matter  in  the 
hepatic  cells  post-mortem. 

Aloes,  Oil  of  Turpentine,  and  JRhubarb,  acted  much  as  Nitro- 
muriatic  Acid. 

Antimony  promoted  in  the  liver,  as  in  all  the  mucous  mem- 
branes, a  copious  flow  of  water  and  mucus.1 

"We  have  thus  in  our  Pharmacopoeias  most  powerful  agencies 
for  modifying  the  quantity  and  quality  of  the  bile.  And  it 
cannot  be  doubted  that  further  inquiry  may  extend  widely  our 
knowledge  of  the  nature  of  our  already  existing  numerous  tools, 
so  as  to  confer  incalculable  benefit  on  rational  medicine.  Che- 
mistry cannot  render  a  reason  of  their  mode  of  action;  it  has 
in  it  something  essentially  vital,  or  if  you  like  the  term  better, 
.tially  physiological.  Still  we  must  bear  in  mind  that,  as 
lar  as  we  can  see,  it  is  temporary;  and,  since  no  one  would 
wish  to  continue  their  use  for  life,  we  must  mainly  depend  in 
the  end  on  more  direct  restoratives  of  life  for  final  cure,  such 
pointed  out  in  the  experiments  on  food. 

Mercury  certainly  is  a  powerful  temporary  relief,  but  the 
sanguineous  congestion  of  the  liver  seen  in  Dr.  Jones'  experi- 
ments should  warn  us  against  tru.-ting  to  it.  Again  and  again 
the  rough  clearance  has  to  be  resorted  to,  till  increasing  n< 
sity  for  it  alarms  the  patient,  ami  points  to  the  ana-mia  and 
weakness  which  are  the  inevitable  consequences  of  an  habitual 
employment  of  that  drug. 

I  understand    there    is    the    same    objection    to    Colchicum. 
-e  I  know  nothing  about. 

1  "  M»"lir»-niirnriM.-.il  Tran.-artions,"  vol.  xx\v.  j>.  240,  an<l  '•  Molieal  Times 
and  Gazette"  for  March  1'.'. 


256  FLATULENCE. 

Nitro-muriatic  Acid  and  Aloes  I  am  pleased  with  as  bile 
promoters.  The  longer  they  are  used  the  less  they  are  re- 
quired. Turpentine  and  Ehubarb  are  too  nasty  for  continuous 
use.  • 

The  chronic  action  of  Antimony  on  the  digestiv  e  viscera  I 
have  not  experience  of. 

But,  as  I  said  before,  it  is  to  a  renewal  of  life  by  nutriment 
that  we  look  for  cure.  To  which  undertaking  science  con- 
tributes the  following  observations.  It  was  found  by  Drs. 
Bidder  and  Schmidt  that  a  full  diet  augmented  not  only  the 
quantity  of  the  bile,  but  also  the  amount  of  material  therein. 
Thus  whilst  a  cat  on  ordinary  diet  secreted  0.807  of  a  gramme 
per  kilogramme  of  weight  hourly,  and  of  solid  material  0.045 
of  a  gramme,  on  very  full  flesh  diet  the  secretion  was  in  one 
cat  1.185  gramme  of  fluid,  and  0.062  of  a  gramme  of  solid,  in 
another  1.003  of  fluid,  containing  0.063  of  solid.  The  same 
fact  was  fully  confirmed  by  observations  also  upon  dogs  and 
geese,  the  details  of  which  correspond  to  the  above.1 

Flesh  diet  causes  the  secretion  of  more  bile  than  vegetable  food. 
For  example,  in  an  experiment  made  by  Dr.  Nasse  on  a  dog,2 
a  diet  of  bread  and  potatoes  caused  a  daily  secretion  of  171.8 
grammes,  in  which  was  6.252  of  solid  matter  ;  whilst  meat  made 
it  amount  to  208.5  of  fluid,  or  7.06  of  solid  residue. 

Water  increases  the  quantity  of  the  bile  within  an  hour  after 
it  is  drunk,  and  not  only  the  quantity  of  fluid,  but  also  of  the 
solid  contents,  though  in  a  less  proportion.  Thus  a  dog  weigh- 
ing about  5  kilogrammes,  which  after  a  meal  of  185  grammes 
of  beef  alone  secreted  in  an  hour  2.283  grammes  of  bile  with 
0.135  of  solid  matter  in  it ;  after  a  meal  of  25  grammes  of  beef 
and  158  of  water  secreted  4.030  of  fluid,  and  0.117  of  solid  bile. 
And  the  same  dog,  after  185  grammes  of  water  alone,  made 
no  less  than  5.165  of  bile,  or  0.143  of  solid  matter.  And  the 
same  thing  was  observed  in  the  three  other  similar  experi- 
ments. 

To  this  Dr.  Nasse  adds,  that  though  water  increases  the  fluid 

1  "Die  Verdauungssafte." 

2  Nasse,  "  Couiuientatio  Je  Bilis  quotidie  a  caue  secret^  copia,"  &c.     Marburg, 
1851. 


FLATULENCE.  257 

bile  and  al->  the  organic  solid  constituents,  it  does  not  have  the 
like  effect  on  the  amount  of  salts. 

On  the  other  hand,  it  was  found  by  Bidder  and  Schmidt  that 

fatty  fond  instead  of  increasing,  as  might  have  been  expected  on 

chemical  grounds,  the  quantity  of  bile,  extraordinarily  dimi- 

•s  it.     Thus  in  a  mean  of  three  experiments  on  cats,  the 

hourly  discharge  after  a  diet  of  pure  fat  was  of  bile  0.327,  of 

solid  matter  in  it  0.036  of  a  gramme.     We  might  have  sup- 

1   that  the  formation   of  a   substance   which  is   the   most 

hydro -carbonaceous  in  the  body  would  have  been  promoted  by 

a  peculiarly  pure  hydro-carbon  aliment:  but  such  is  not  the 

Nay,   so  far   from    it,    that  the   numbers   given  above 

correspond  most  closely  to  what  would  probably  have  been  the 

quantity  of  bile  secreted  by  the  animals  in  a  state  of  complete 

deprivation  of  food.     Fat  appears  to  be  eminently  "bilious,"  as 

the  vulgar  tongue  expresses  it,  that  is  to  say,  it  diminishes  the 

vitality  of  the  liver. 

Alcohol  also  by  arresting  metamorphosis1  must  be  hurtful,  as 
tending  to  diminish  the  normal  formation  of  bile. 

The  rules  then  of  diet  in  intestinal  flatulence  should  be — (1) 
to  Use  a  full  allowance  of  lean  meat  and  water ;  (2)  to  Avoid 
utter,  and  rich  sauces  ;  and  (3)  to  Diminish  the  allowance 
of  alcohol. 

None  of  these  special  items  of  treatment  however  diminish 
the  importance  of  general  treatment.  Iron  when  there  isanaemia, 
and  the  nerve-tonics  Quinine  ;md  Strychnine  when  there  is  not, 
are  what  I  use  myself,  and  it  is  very  rare  that  I  wander  from 
old  inend<  into  the  fields  of  experiment  without  regret- 
tinir  it.  Indeed  the  general  treatment  will  oft-times  render 
DeedlefSfl  the  special,  as  it  did  in  the  following  recent  instance. 

t'i  XXX. —  A  maiden  l:idy  past  furty.  of  span-  wiry  built!  and  sharp 
decided  manners,  came  in  ihc  tirst  week  "f  l-i'-T.  on  account  of  tin-  inconve- 
nience, nay  po.-sildy  scandal,  which  >he  *uff<Mv<l  from  u  continually  increa-inir 
Rwellin-r  of  tin-  ulidoincn.  It  varied  from  time  to  time,  yet  had  steadily  aug- 
mented fur  several  months.  Latterly,  when  it  \v.i>  largest,  .-die  had  Ml  palpi- 
tations ,,f  the  heart  and  in  the  epi-n-trium.  especially  when  sitting  still  for 
longer  than  usual.  The  ankles  ulso  frequently  were  pally,  taking  the  uaurk 

;!y  Clinical,"  L»>ct.  L,  "On  Alcojiol." 

17 


258  FLATULENCE. 

of  the  boot  in  an  unaccustomed  way.  The  catamenia  were  quite  regular  and 
sufficient,  the  tongue  was  clean,  the  bowels  were  natural  in  action  ;  and  the 
only  abnormal  secretion  was  the  urine,  which  was  sometimes  thick,  and  caused 
pain  apparently  from  excess  of  acidity.  There  was  no  hysteria. 

The  abdomen  was  tight  and  round,  and  large  for  a  person  of  her  stature. 
It  was  very  resonant  on  percussion  throughout.  There  was  no  glugging  on 
pressure,  and  the  patient  stated  that  air  very  rarely  escaped  per  anum  even 
at  stool. 

I  desired  her  to  wear  an  Elstob's  belt,  and  to  take  -i  of  a  grain  of  Strychnia 
with  three  grains  of  Quinise  et  Ferri  Citras  twice  a  day  ;  also  at  night  another 
similar  dose  of  Strychnia  in  a  pill  with  two  grains  of  Aloes  and  Myrrh  mass, 
and  the  same  quantity  of  Extract  of  Hyoscyamus. 

I  saw  her  twice  more  at  intervals  of  about  ten  days,  and  as  the  belly  became 
softer  was  able  to  make  sure  of  the  absence  of  any  solid  substructure  to  the 
tumefaction.  She  went  home  quite  slim  and  comfortable,  but  still  denied 
having  expelled  any  explanatory  amounts  of  air  by  the  external  vents. 

As  to  the  cause  of  her  disease,  I  found  that  she  kept  house  for  her  father, 
an  old  and  infirm  medical  man  in  a  remote  province.  Whenever  she  consulted 
him  about  any  little  ailments,  he  always  gave  her  purgatives,  and  the  more 
abnormal  the  alvine  secretions  became,  the  more  purgatives  he  gave  her. 

I  suppose  this  treatment  had  produced  anaemia  and  reaction 
of  the  ilia,  which  as  a  chronic  condition,  continually  tending  to 
increase  itself,  had  gone  on  from  worse  to  worse  till  the  parietal 
muscles  had  also  become  relaxed.  It  is  true  that  general 
anaemia,  indicated  by  a  pallid  condition  of  the  lips,  tongue,  and 
mucous  membranes,  had  not  as  yet  arisen ;  but  yet  it  might 
have  existed  in  the  local  organs  affected.  I  have  noticed  that 
persons  of  middle  age  become  generally  anaemic  in  consequence 
of  imperfect  digestion  much  more  slowly  than  the  young.  For 
the  life  of  the  latter  rapid  renewal  of  the  tissues  is  such  an 
essential  feature,  that  a  check  to  the  rapidity  tells  much  more 
severely  on  their  health  than  it  does  in  the  case  of  adults,  and 
still  more  of  old  people.  Probably  this  is  the  reason  why  con- 
sumption is  so  "  galloping"  in  youth,  so  sluggish  in  old  age ; 
and  why  starvation  makes  such  havoc  among  young  paupers, 
while  on  the  same  dietary  their  grandparents  may  struggle  on 
with  a  half  life  to  the  extreme  term. 

The  intention  of  the  belt  prescribed  in  the  above  case  was  to 
strengthen  the  contractile  force  of  the  abdominal  muscles,  just 
as  a  bandage  is  put  round  a  woman  after  childbed  to  restore 
her  pristine  figure.  It  affords  the  fibres  a  firm  basis  of  contrac- 
tion, so  that  they  recover  from  the  half-palsied  state,  and  do 


FLATULENCE.  259 

not  again  fall  into  it.  Its  pressure  therefore  should  be  even, 
ami  need  not  be  very  great.  I  mention  this  because  patients 
are  apt  to  mistake  the  object  of  the  appliance,  to  suppose  that 
it  is  designed  to  expel  the  retained  air  by  compression,  to  be 
disappointed  when  it  does  not  do  so,  and  to  tighten  it  too  much. 
N"W  too  great  constriction  acts  unevenly,  and  produces  the  bad 
local  e fleet  of  ill-litting  i-v 

in  (he  colon  requires  the  same  medicinal  and  dietetic 
treatment  as  that  of  the  intestines.  "When  there  is  a  tendency 
to  congestion  of  the  rectum  and  to  piles,  as  not  unfrequently 
happens,  cold  water  enemata  are  useful,  and  in  elderly  persons 
a  rarininative,  such  as  Extract  of  Rue,  or  a  few  drops  of  Ether, 
may  bo  added  to  the  enemata. 

When  the  abdomen  is  not  much  more  dilated  than  natural 
by  flatulence,  efforts  should  always  be  made  to  retain  the  air 
inside  the  bowel  till  the  period  of  fecal  evacuation.  For  not 
uncommonly  the  parting  with  it  induces  a  condition  of  consti- 
pation. If  retained,  it  may  roll  about  uncomfortably  for  a  time, 
l>ut  will  soon  either  become  absorbed  or  mixed  up  with  the 
feces,  and  so  assist  their  normal  evacuation,  as  described  in  a 
previous  page.1  The  proof  of  that  is  that  it  is  not  afterwards 
-ed. 

1  See  page  242. 


260 


CHAPTEE   VII. 

DIARRHOEA. 

Difference  of  diarrhoea  from  mere  frequency  of  evacuation. — Subdivision  of 
forms. — Their  causes  and  indications. — Supplementary  and  reflex  diarrhoea. 
— Infantile. — Diarrhoea  in  typh-fever. — Ulceration  of  bowels.  —  Mucous  flux. 
— Copious  solid  diarrhoea. — Acid  diarrhoea. — Use  of  opium. — Riding  in  chronic 
cases. — Cautions  to  travellers. 

WHEN  the  absorbing  power  of  the  intestines  is  defective,  the 
consequence  is  an  excess  in  the  quantity  of  matters  which  pass 
through  them  ;  that  which  ought  to  be  taken  up  is  carried  along 
out  into  the  normal  draught,  and  so  constitutes  a  true  diarrhosa. 

It  is  of  great  practical  importance  to  distinguish  this  from 
the  mere  frequency  of  evacuation,  which  is  quite  consistent 
with  a  natural  or  even  with  a  deficient  amount  of  feces.  The 
number  of  motions,  or  the  number  of  times  an  inclination  is 
felt  to  void  them,  is  often  increased,  while  even  less  than  the 
average  quantity  may  be  passed  in  the  twenty-four  hours.  This 
affection  is  of  the  nature  of  tenesmus,  and  arises  from  some 
tissue  lesion  of  colon  or  rectum ;  whereas  true  diarrhoea,  as 
aforesaid,  depends  upon  defective  function  of  the  ilia. 

The  arrest  of  function,  as  declared  by  the  prevailing  contents, 
of  the  stools,  constitutes  the  best  principle  of  division  which 
has  been  moreover  adopted  in  the  chapter  on  Vomiting ;  and 
according  to  it  we  may  speak  without  much  danger  of  being 
misunderstood  of  Crapulous,  Bilious,  Serous,  Dysenteric,  and 
Choleraic  diarrhoea. 

Crapulous  diarrhoea  is  simply  an  excessive  quantity  of  food 
taken,  or  the  natural  quantity  arrested  in  its  solution  by  sus- 
pension in  the  gastric  function.  I  call  it  "  crapulous,"  because 
it  is  most  usual  after  a  debauch ;  but  in  weakly  persons  it  is  not 
necessary  that  the  intemperance  should  be' absolute;  that  which 
is  moderation  for  others  may  be  an  excess  in  them.  An  exami- 


DIARRH(EA.  261 

nation  of  the  feces  exhibits  a  quantity  of  undigested  food  as  the 
prominent  feature,  sometimes  fetid  ami  fermenting,  and  deficient 
in  the  bile  which  should  prevent  decomposition. 

/.'         i  diarrhu-a  is  the  next  simplest  form  of  the  disorder. 

Bile,  normally  poured  out  by  the  liver  to  the  extent  of  from 

three  to  four  pints,  a  day,  if  not  concentrated  by  the  intestinal 

rption,  adds  largely  to  the  excrements,  where  its  presence 

•••lared  by  its  well-known  smell,  and  by  a  color  exhibiting 

various  shades  of  yellow,  brown,  and  olive-green,  according  to 

its  absorption  of  oxygen  and  mixture  with  feces. 

The  arrest  of  the  absorbing  powers  of  the  intestines  and  the 
-•'quent  rejection  of  bile,  mixed  at  first  with  feces,  and  aug- 
mented by  the  exudation  of  water  from  the  intestinal  pariei 
what  so  often  happens  in  comparative  health  from  the  impression 
of  cold,  from  irritation  of  the  alimentary  canal  by  unwholesome 
food,  and  from  mental  emotion.     It  is  possible  also  that  the 
qualities  of  the  bile  itself  may  be  altered  in  some  cases,  or  its 
quantity  may  be  increased.     It  may  be  poisoned  by  drugs,  as 
by  Calomel  or  by  Senna,  and  so  rendered  incapable  of  absorp- 
and  be  poured  through  the  ilia  without  their  being  in  fault. 
11.  cnn:_'.-stion  of  the  liver  and  of  the  portal  veins,  such  as 
pecially  frequent  in  Europeans  resident  in  warm  climates, 
causes  the  bile  to  be  at  one  time  deficient,  and  afterwards  to  be 
poured  out  in  excess.     Or  irritation  of  the  stomach  and  duo- 
denum may  cause  it  to  be  retained  in  the  liver  and  gall-bladder 
till  it  is  unfit  for  absorption.     In  such  cases  bile  is  rejected 
per  a  tin, a  and  constitutes  the  matter  excreted  in  true  bilious 
diarrhoea. 

\Ve  should  distinguish  this  symptom  from  a  different  one 
sometimes  confounded  with  it — viz.,  the  presence  of  a  light 
BOD  matter  in  the  stools.  This  is  not  bile  at  all,  but 
altered  blood,  and  denotes  inflammation  of  the  mucous  mem- 
brane, a  state  requiring  very  opposite  treatment  from  that 
proper  for  bilious  diarrhoea.  Our  best  aids  to  diagnosis  are — 
first,  the  smell:  in  real  bilious  -tools  the  odor  of  the  hepatic 
secretion  can  always  be  ]  i.  in  spite  of  the  feces  mixed 

with  it;  while  in  the  Ifl  tin-  smell  is  not  of  bile, 

but  more  or  less  putrid.     Secondly,  the  microscope  exhibits  in 


262  DIARRHCEA. 

the  mucus  the  usual  globules  mixed  with  small  shreds  of  fibrin 
and  blood-globules. 

In  Serous  or  Watery  diarrhoea  it  is  probable  that  there  is  an 
increased  exhalation  of  aqueous  fluid  from  the  bloodvessels  of 
the  intestines,  as  well  as  an  arrest  of  its  absorption.  In  this 
form,  when  pure,  if  the  feces  are  retained  by  a  voluntary  effort, 
they  may  be  concentrated  nearly  to  their  normal  condition  by 
the  removal  of  the  water,  and  thus  a  test  afforded  that  their 
state  depends  mainly  on  the  addition  of  this  constituent.  For 
that  which  can  be  so  readily  taken  up  again  into  the  blood 
cannot  be  of  a  nature  very  foreign  to  it.  For  example,  in  the 
diarrhoea  produced  by  a  saline  purgative  you  may  feel  several 
pints  of  fluid  rolling  about  in  the  bowels;  but  if  you  resist  the 
inclination  to  stool,  it  goes  off  at  last,  and  you  void  afterwards 
little  more  than  the  ordinary  amount  of  semi-solid  feces.  It  is 
not  so  in  bilious  or  inflammatory  diarrhoeas :  you  cannot  cause 
the  absorption  of  the  fluid  by  forcible  retention. 

Watery  diarrhoea,  when  not  arising  from  the  action  of  drugs, 
indicates  a  congested  state  of  the  venous  plexus  of  the  alimentary 
canal,  and  a  consequent  morbid  proneness  to  deficiency  in  ab- 
sorption. The  vitality  of  the  mucous  membrane  is  deficient ; 
and  if  it  be  not  restored,  local  death,  exhibited  in  the  form  of 
ulcers  and  sloughs,  must  result.  The  exhalation,  however, 
tends  to  become  habitual,  and  so  continues  beyond  the  period 
of  congestion,  so  that  the  whole  mass  of  blood  is  relieved  of  its 
water,  and  in  this  way  sometimes  dropsical  swellings  may  be 
reabsorbed  and  pass  off  through  the  bowels. 

In  Dysenteric  or  Afuco-purulent  diarrhoea,  water  is  also  in 
excess,  but  the  characteristic  feature  is  the  presence  of  mucus 
or  pus  mixed  with  it ;  in  which  also  there  are  shreds  of  fibrin, 
blood-globules,  and  flakes  of  the  epithelium  of  the  bowels. 

Should  any  of  these  products  of  inflammation  be  unmixed 
with  feces,  then  it  is  probable  they  come  from  the  colon  or 
rectum ;  but  if  they  are  mixed  up  with  a  large  quantity  of 
watery  fluid,  and  still  more  if  that  watery  fluid  shows  itself  to 
be  the  serum  of  the  blood  by  coagulating  with  heat,  then  there 
is  little  doubt  of  their  source  being  the  mucous  membrane  of 
the  ilia.  The  fluid  in  muco-purulent  diarrhoea  is  always  highly 
alkaline,  and  if  it  be  examined  with  the  microscope,  phosphatic 


DIABRH(EA.  263 

tre  found  scattered  through  it.  If  allowed  to  stand,  it 
into  two  parts:  the  one  serous,  varying  from  trans- 
parent whiteness  through  all  the  shades  of  yellow  to  deep 
brown;  or,  where  blood  be  present,  to  red  and  black,  in  which 
are  the  flakes  of  fibrin,  the  ammoniacal  crystals,  and  floating 
globules;  the  other  i  /•?/,  consisting  principally  of  gray, 

irranular  matter,  the  debris  of  food  mixed  with  more  or  less  of 

•loring  matter  of  the  bile  and  half-digested  blood. 
The  degree  of  serosity  and  the  proportion  of  the  products  of 
inflammation  in  the  first,  show  the  extent  to  which  inflamma- 
tion has  gone  in  the  mucous  membrane;  whiteness,  bloodiness, 
putridity,  alkalinity,  being  bad  signs;  yellowness,  opacity,  the 

11  of  bile,  and  the  absence  of  putridity,  being  good. 
The  second,  or  sedimentary  portion  proves  the  condition  of 
the  general  system  rather  than  of  the  ilia  in  particular.     If  it 
be  copious  in  proportion  to  the  fluid,  then  the  normal  function 
of  destructive  assimilation  is  shown  to  be  little  interfered  with  ; 
uitv,  then  we  know  this  process  to  be  arrested,  the  effete 
.'•s  are  not  removed  from  the  body,  and  we  have  to  do  with 
a  more  grave  state  of  affairs.     The  quantity  of  solid  matter  is 
the  '  of  an  advance  towards  health,  or  departure  there- 

from, in  all  cases  where  there  is  this  state  of  the  bowels. 

The  most  common  examples  of  muco  purulent  diarrhoea  are 
found  amongst  acute  diseases,  in  low  fever,  enteritis,  and  dysen- 
ly  in  the  teething  dysentery  of  children.     Amongst 
chronic  in  ulceration  of  the  bowels,  whether  a  conse- 

quence of  phthisis  or  low  fever,  it  is  the  most  usual  course  for 
the  symptoms  to  take. 

-A/  diarrh<ea,  where*  the  blood  is  in  small  streaks  in  the 
mucus,  or  slightly  mixed  with  the  serum,  or  mixed  with  the 
grass-green  mucus  al>  libe.l,  shows  recent  inflammation. 

When  it  is  in  clots,  either  black  or  fibrinous,  with  the  globules 
partiallv  washed  away,  that  a  bloodvessel  of  notable  si/e  has 
be. MI  opeiifl,  probably  by  ulceration.  Should  pus  be  mixed 
with  it,  the  <!  of  uleeratiun  is  confirmed.  Black  semi- 

I  blood,  precipitated  by  standing  with  the  sediment  of 
fluid  stools,  comes  from  high  in  the  alimentary  canal,  not  seldom 
from  the  stomach  itself. 

Putridity  of  the  stools  in  diarrhoea  always  shows  that  there  is 


264  DIARRHCEA. 

an  imperfect  quantity  of  bile,  one  of  the  most  clearly  ascertained 
functions  of  the  hepatic  secretion  being  to  prevent  decay  of 
albumen.  Putridity  may  arise  from  two  sources — namely,  the 
food  taken,  or  the  secretions  into  the  canal.  A  close  examina- 
tion of  the  stools  will  generally  distinguish  them ;  for  if  it  is . 
non-digested  food  which  is  decaying,  then  the  solid  constituents 
of  the  feces  are  bulky,  pale,  containing  large  lumps  of  still 
paler  substance,  which  under  the  microscope  will  be  found  to 
consist  of  muscular  fibre,  fat,  and  other  parts  of  victuals,  often 
swarming  with  infusoria.  Whereas,  if  the  fetor  arise  from  the 
decomposed  albumen  of  the  serum,  it  will  be  observed  to  exhale 
from  the  more  fluid  part  of  the  motions,  which  smell  like  the 
washings  of  macerated  flesh,  while  the  solid  part  is  scanty  and 
comparatively  unaffected.  This  shows  a  much  more  serious 
state  of  the  vital  powers,  and  in  severe  complaints  is  often  the 
harbinger  of  death,  especially  if  joined  to  a  peculiar  mouse-like 
smell  in  the  sweat. 

In  Choleraic  diarrhoea  the  whole  of  the  blood  is  so  altered  in 
its  physical  qualities  that  little  of  it  remains  capable  of  support- 
ing life,  or  of  absorbing  the  wherewithal  to  support  life.  The 
functions  of  the  liver  and  kidneys  are  suspended  for  want  of 
live  blood,  no  bile  appears  in  the  stools  or  vomit,  no  urine  in 
the  bladder. 

For  the  purpose  of  comparing  the  degree  in  which  life  is  de- 
ficient in  the  different  forms  of  diarrhoea,  I  subjoin  a  table  in 
which  the  first  column  is  occupied  by  the  several  functions,  the 
loss  of  one  or  more  of  which  characterizes  those  different  forms. 
It  will  be  seen  that  the  sign  of  minus  can  be  placed  against  one 
after  the  other  till  the  normal  condition  of  all  is  finally  lost,  as 
an  essential,  not  accidental,  part  of  the  disease. 


DIARRHOEA. 


265 


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266  DIARRHCEA. 

In  some  rare  instances  of  mucous  flux  the  stools  are  acid  from 
time  to  time.  There  is  nothing  special  in  the  pathology  of  this. 
It  arises  simply  from  so  much  acid  being  formed  from  the  de- 
composition of  undigested  food,  that  it  cannot  be  neutralized  by 
the  alkaline  juices.  The  acidification  takes  place  apparently  in 
the  caecum,  during  the  delay  of  the  decomposing  aliments  there; 
for  considerable  pain  is  often  experienced  in  the  right  iliac 
region,  and  in  the  course  of  the  colon,  just  before  the  evacuations. 

In  all  forms  of  diarrhoea  from  affections  of  the  small  intes- 
tines, the  evil  is  twofold :  first  the  aliment,  which  ought  to  con- 
tribute to  the  support  of  the  system,  is  hurried  through  the 
abdomen,  and  so  the  supplies  are  cut  off;  and  secondly,  de- 
struction is  carried  on  at  an  increased  rate  by  exhalation  from 
the  mucous  membrane  of  the  bowels.  The  stick  is  being  cut 
away  at  both  ends,  and  hence  there  is  nothing  which  produces 
such  rapid  emaciation.  Where  so-called  "  diarrhoea"  is  reported 
to  you  as  lasting  for  any  length  of  time  without  emaciation, 
always  let  your  suspicions  of  the  correctness  of  the  nomencla- 
ture be  roused,  and  observe  carefully  whether  the  quantity  of 
excrement  be  really  in  excess,  or  whether  the  ailment  have  not 
rather  the  nature  of  tenesmus,  and  arise  from  the  colon  or 
rectum.  You  will  generally  find  such  to  be  the  fact,  and  must 
vary  your  treatment  accordingly. 

Sometimes  diarrhoea  seems  to  be  the  transference  of  a  ten- 
dency to  exudation  of  serum  from  another  tissue  to  the  alimen- 
tary canal.  Such  is  that  which  sometimes  comes  on  of  its  own 
accord  or  may  be  artificially  induced  in  ascites,  and  which  cer- 
tainly sometimes  diminishes  the  abdominal  collection.  Such  is 
the  diarrhoea  of  uraemia,  which,  however,  does  not  usually  re- 
lieve anasarca,  but  rather  increases  it  from  the  weakening  of 
the  blood  which  follows.  Hence  it  is  a  very  bad,  almost  a  fatal 
symptom,  in  Bright's  disease. 

The  most  important  part  of  treatment  is  the  diet.  It  must  be 
such  as  does  not  need  a  perfect  state  of  the  digestive  organs  for 
its  absorption,  while  at  the  same  time  it  is  nutritive  to  the 
patient.  The  best  of  all  is  milk  and  Lime-water.  In  feverish 
cases  it  may  be  iced,  and  Soda-water  may  be  occasionally  substi- 
tuted for  the  Lime.  Keeping  a  person  solely  on  this  diet  is 
often  alone  sufficient  to  cure  all  sorts  of  diarrhoea  not  dependent 


DIARRH(EA.  267 

on  a  permanent  chronic  cause ;  and  even  where  there  is  such  a 
for  it,  much  temporary  benefit  is  derived,  and  a  sounder 
starting-point  for  medical  treatment  than  the  previous  state  is 
gained. 

In  a  temporary  diarrhoea  without  other  disease,  the  loss  of 
the  normal  supply  to  the  body  is  not  of  much  consequence;  a 
short  starvation  perhaps  does  good  to  a  person  otherwise 
health v.  But  in  severe  acute  disease,  or  in  long-continued 
chronic  diarrho.-a,  this  is  an  important  consideration,  and  care 
must  IK?  taken  to  allow  for  it.  Since  food  in  the  usual  quanti- 
at  once  cannot  be  borne,  and  is  rejected  undigested,  give  it 
very  frequently  in  small  portions.  The  alkaline  milk  diet  T 
just  recommended  allows  this  to  be  done  most  conveni- 
ently. A  jug  of  the  liquid  must  be  kept  close  at  hand  and 
sipped  from  time  to  time,  so  that  as  much  nutriment  may  be 
taken  in  the  twenty-four  hours  as  would  be  done  by  a  healthy 
person. 

It  is  a  good  rule  when  there  are  lumps  of  feculent  matter  in 
the  stools  and  a  smell  like  that  of  normal  excrement,  to  give 
purgatives,  and  when  there  is  no  normal  smell  present,  to 
abstain.  For  it  is  only  the  remains  of  previous  constipation 
that  require  to  be  got  rid  of,  and  when  they  are  not  present, 
harm  is  done  by  purgation.  I  have  known  cases  of  chronic 
diarrlnea  much  injured  by  the  routine  practice  of  so  beginning 
treatment. 

Where  the  products  of  acute  inflammation  are  found  mixed 
in  the  stools,  such  as  white  and  opaque  mucus,  flakes  of  fibrin, 
epithelium,  blood-streaked  mucus,  bright  green  matter,  &c.,  as 
above  described,  then  Leeches,  Fomentations,  warm  Hip-baths, 
and  poultices  to  the  abdomen  are  appropriate  and  should  not 
lie  dflaved.  In  children,  the  whole  abdomen  and  loins  maybe 
ied  up  in  a  large  circumambient  Poultice,  which  they 
cannot  wriirirle,  away  i'rom,  a  Leech  put  on  near  the  navel, 
and  the  bite  allowed  to  bleed  for  a  little  time.  The  artie'< 
matt-ria  medica  I  have  m«>-t  trust  in  are  Opium,  [peoaoaanb*, 
ami  Carhonate  of  Soda.  A  syrup  may  !>«•  made  often  drops  of 
Laudanum,  two  grains  of  Ipecacuanha  powder,  and  a  scruple  of 
S»da  in  an  ounce  of  half  t :  .d  half  water,  ami  dt>se>  •>!'  not 

"•nt'ul  given  at  hour  intervals.     1  have  found  this 


268  DIARRHCEA. 

answer  better  than  the  old  plan  of  administering  Calomel.  In 
teething  infants  this  treatment  is  of  the  most  marked  utility. 
I  suppose  the  anodyne  soothes  their  neuralgia.  In  their  case, 
too,  lancing  the  gums  will  sometimes  stop  a  most  violent 
diarrhoea  where  the  stools  show  evident  proofs  of  the  inflamma- 
tory condition  of  the  ilia.  The  action  of  the  lancing  is  probably 
much  the  same  as  that  of  Leeches,  viz.,  a  relief  to  the  conges- 
tion of  the  mucous  membrane.  Upon  the  protrusion  of  the 
teeth  it  can  hardly  be  supposed  to  have  any  influence,  but  that 
it  alleviates  toothache  any  adult  may  experience  for  himself, 
though  it  is  impossible  to  get  from  his  little  patients  an  account 
of  this  remedial  effect. 

But  there  is  no  doubt  that  the  most  active  cure  in  infantile 
diarrhoea  is  change  of  diet.  Bringing  up  by  hand  or  unwhole- 
some states  of  the  breast-milk  are  generally  at  the  bottom  of 
the  ailment.  No  remedy  is  equal  to  a  healthy  wet-nurse,  or 
where  prejudice  forbids  that,  as  near  an  imitation  as  can  be 
made  of  human  milk  by  that  of  animals,  such  as  the  donkey's, 
or  the  cow's  diluted  and  slightly  sweetened. 

In  low  fever  the  presence  of  diarrhoea  still  suggests  to  many 
practitioners,  and  used  to  suggest  to  many  more,  the  employ- 
ment of  Mercury.  The  effect  of  this  is  the  increase  of  solid 
sedimentary  matter  in  the  stools;  in  other  words,  a  restoration 
of  the  destructive  assimilation  going  on  in  the  body.  The 
motions  are  diminished  in  number  and  in  fluidity,  but  not  in 
actual  quantity.  In  fact  more  solid  effete  matter  is  excreted, 
and  thus  the  tissues  devitalized  by  the  typh  poison  are  removed, 
and  room  is  made  for  new  nutriment.  This  increase  of  solid 
matter  is  taken  as  an  evidence  and  test  of  benefit  accruing  from 
the  use  of  Mercury,  and  as  a  prognosis  of  good.  But  I  must 
say,  without  reserve  (and  am  glad  of  the  opportunity  of  so 
doing),  that  I  think  this  an  unwise  hurrying  of  nature  ;  for  only 
the  destructive  assimilation  is  augmented,  not  the  constructive, 
and  thus  the  powers  of  the  body  and  its  resistance  are  lowered. 
Now  the  use  of  Hydrochloric  Acid  both  stops  diarrhoea  and 
increases  at  the  same  time  absorption  in  the  intestinal  canal. 
For  some  years  therefore  I  have  employed  no  other  remedy  in' 
low  fever,  and  with  decided  success,  as  I  have  more  largely  set 
forth  in  my  published  "  Clinical  Lectures." 


DIARRHffiA.  269 

Where,  in  the  absence  of  fever,  blood  is  passed  by  the  bowels, 

tin'  two  most  powerful  means  of  checking  it  I  have  found  to  be 

Turpentine   ami   Acetate  of  Lead.   especially  the  latter.      Its 

direct  influence  as  a  poison  on  the  bowels  would  have  led  to  an 

ration  of  this.     If  the  hemorrhage  has  gone  on  for  some 

time,  I  am  inclined  to  think  it  must  be  sometimes  due  to  a  clot 

distending  the  bowel,  and  preventing  it  contracting  upon  the 

iing  spot,  for  certainly  a  dose  of  Castor  oil,  in  the  results 

of  whose  action  a  quantity  of  pale  clots  were  exhibited,  has 

al  times  in  my  experience  stopped  bleeding. 

l>iarrlnjea  from  ulceration  of  the  ilia  tends  to  prolong  itself; 

for  the  weaker  the  system  is,  the  more  irritable  are  the  sore 

aid  the  less  can  the  morbid   actions  they  set  up  be 

It  is  wrong,  therefore,  to  let  it  go  on  an  hour  longer 

than  we  can  help.     The  readiest  means  for  arresting  it  are  such 

as  M unt  the  sensibility  of  the  ulcerated  spots.     Milk-and-lime- 

•  liet  should  be  used  first,  then  Chalk  and  Opium,  which 

appear  to  act  on  the  sore  mucous  membrane  just  as  they  do  on 

a  raw  blistered  surface  of  skin.    If  these  fail,  Sulphate  of  Copper 

should  be  used  in  doses  increased  from  a  quarter  of  a  grain  up 

to  two  grains. 

Where  there  is  a  simple  flux  of  transparent  mucus  without 

:  or  pain  on  pressure,  and  no  fibrin  or  blood  in  the  motions, 

vegetable  astringents,  such  as  Logwood,  Bark,  Kino,  and 

Tannin,  are  often  of  great  use.     In  such  cases,  too,  I  have  pre- 

d  Iron,  in  the  form  of  the  Tincture  of  the  Sesquichlo: 
with  seeming  benefit.     I  must,  however,  say,  that  I  feel  doubt- 
ful in  the  greater  number  of  cases  whether  this  form  of  flux  be 
not  due  rather  to  the  colon  than  to  the  ilia. 

Where  the  solid  matter  is  pale,  fetid,  and  consists  mainly  of 
undigested  food,  inspissated  bile  may  be  given  with  benefit ; 
the  stools  Itecom.  id  and  less  frequent  under  its  employ- 

ment. This  is  particularly  the  ease  in  children  whose  rnesenterie 
glands  are  diseased.  IVp.-ine  also  diminishes  the  fetor  of  the 
motions  in  the  best  way — namely,  by  promoting  the  normal 
solution  of  the  food,  and  acting  as  a  <i.  :orative. 

Acid  d-iarrho-a  indicate,  tin'  free  employment  of  Chalk. 
The  use  of  Opium  in  diarrho-a  must  never   be  made  a  m. 
of  routine.     As  a  general  rule,  I  have  found  it  beneficial  with- 


270  DIARRHCEA. 

out  consequent  harm  in  cases  where  there  was  tenesmus  and 
frequent  stools ;  but  where  the  feces  are  bulky  and  copious  it 
appears  to  impede  the  natural  secretion.  Where  the  stools  also 
are  putrid,  caution  is  required  in  its  use.  In  the  diarrhoea 
which  so  often  accompanies  and  proves  fatal  in  ursemia,  it 
checks  the  debilitating  flux,  but  is  apt  to  bring  on  coma. 

In  some  cases  of  diarrhoea  from  chronic  mucous  flux  of  the 
intestines,  without  ulceration  or  acute  inflammation,  I  have 
known  horse  exercise  to  be  serviceable.  I  suppose  it  is  the 
gentle  agitation  of  the  abdomen,  combined  with  the  air  and 
amusement,  that  proves  of  use. 

In  recommending  the  recreation  of  travelling  to  invalids  sub- 
ject to  diarrhoea,  you  must  be  very  careful  of  the  route  you 
select.  The  epidemic  influence  of  cholera  which  has  overspread 
Europe  during  the  present  generation,  visiting  almost  every 
square  mile  of  its  surface  several  times  during  the  last  few 
years,  has  in  many  places  left  behind  it  a  chronic  endemic 
poison.  The  natives  are  insensible  to  it,  but  few  strangers 
escape  becoming  affected  more  or  less,  according  to  their  idio- 
syncrasies. Strong  persons  find  it  only  an  inconvenience,  but 
an  invalid  is  put  in  some  danger,  and  certainly  loses  all  the 
advantage  of  the  tour.  This  is  especially  the  case  in  the  moun- 
tainous districts  of  the  south  of  France,  the  Pyrenees,  and  Dau- 
phiny,  and  in  the  volcanic  regions  bordering  the  Ehine,  the 
Eifel  and  Moselle  country,  as  well  as  those  in  the  centre  of 
France,  the  ancient  province  of  Auvergne.  All  these  places 
are  attractive  from  their  picturesque  beauties,  and  therefore  it 
is  necessary  that  travellers  should  be  warned  of  this  evil  attend- 
ant upon  choosing  them  as  the  scene  of  a  tour.  It  must  not  be 
supposed  that  this  diarrhoea  is  solely  the  result  of  the  foreign 
modes  of  cooking.  I  have  known  English  biscuits  and  porter, 
and  boiled  eggs,  adopted  as  a  diet  without  relief,  though  of 
course  nothing  foreign  could  have  got  into  them.  I  believe 
the  cause  to  be  as  I  have  represented  it — namely,  a  poison  left 
endemic  since  the  passage  of  cholera  through  the  country,  but 
to  which  the  natives  have  become  acclimatized.  That  it  is  of 
late  years  only  that  this  diarrhoea  has  been  prevalent  is  shown 
both  by  local  report  and  the  omission  of  all  mention  of  it  from 
the  well  known  work  on  "  Climate,"  by  Sir  James  Clark. 


DIARRHCEA.  271 

One  source  from  which  strangers  contract  this  diarrhoea  is  an 
evil  capable  of,  and  loudly  calls  for  amendment :  I  refer  to  the 
filthy  privies  in  continental  inns.  A  gentleman,  lately  eminent 
in  our  profession  and  of  good  judgment,  told  me  that,  during  a 
nean  tour  some  years  ago,  he  entirely  escaped  the  diarrhoea 
which  everybody  else  without  exception  suffered  from,  by  ad- 
hering to  a  strict  rule  of  never  entering  one  of  these  digusting 
9,  but  worshipping  Cloacina  under  the  pure  light  of  the 
stars.  Invalids  and  ladies  cannot  so  well  manage  this,  unless 
they  are  rich  enough  to  travel  with  carriages  and  servants  and 
locomotive  water-closets. 

Those  who  have  already  suffered  are  by  no  means  exempt ; 
indeed  they  would  seem  by  the  occurrence  of  such  cases  as  are 
illustrated  in  CASES  XVIII,  XIX,  and  XX,  to  be  peculiarly 
exposed  to  relapses  from  both  internal  and  cosmical  influences. 

In  Italy  I  have  found  that  the  best  remedy  for  the  diarrhoea 
which  so  often  attacks  travellers  from  over-fatigue  in  summer 
ami  autumn,  is  lemon-juice  and  the  horizontal  posture.  Lying 
down  for  a  couple  of  hours  on  the  back,  and  drinking  two  or 
of  strong  lemonade,  with  very  little  sugar,  gene- 
rally stops  it.  If  that  is  not  successful,  Opium  must  be  had 
arse  to ;  but  it  is  seldom  required  in  that  land  of  lemons. 


272 


CHAPTER  VIII. 
CONSTIPATION  AND  COSTIVENESS. 

Definitions. — SECTION  1. — CONSTIPATION. — From  mechanical  obstruction — Ner- 
vous exaggeration  of  the  sphincters — Catarrh — Atony  of  colon — Insoluble  arti- 
cles of  diet — Remedies.  SECTION  2. — COSTIVEXESS. — From  deficient  excretive 
life — Quality  of  stools — Occasionally  interchanged  with  Diarrhoea — What  dis- 
eases it  accompanies — Effect  on  nervous  system — Indications  of  treatment — 
Inconveniences  of  purgatives — What  sort  of  purgatives  are  to  be  adopted — 
Dietary — Water — Watering  places — Cautions  respecting  the  use  of  them — 
Hydropathy. 

THE  words  which  head  this  chapter  are  sometimes  employed 
as  synonymous ;  but  I  do  not  wish  them  so  to  be  understood 
here.  By  the  former  I  would  imply  injury  to  the  health  from 
the  quantity  of  feces  retained  in  the  alimentary  canal ;  by  the 
latter  a  deficiency  in  the  quantity  expelled  by  reason  of  a  defi- 
ciency in  the  quantity  found. 

SECTION  I. 
Constipation. 

The  expulsive  power  is  relatively  or  absolutely  in  default — 
the  feces,  normal  or  abnormal  in  quality,  collect  in  some  part 
of  the  bowels,  and  give  proof  of  that  collection  by  being  occa- 
sionally passed  in  considerable  quantities  at  a  time.  In  the 
stools  there  are  portions  drier  than  the  general  mass — scybala 
of  various  sizes,  dark  brown  or  black,  and  usually  with  less 
smell  than  ordinary  feces. 

The  most  complete  type  of  constipation  is  that  which  arises 
from  mechanical  obstruction,  to  discuss  which  however  would 
lead  us  too  far  from  the  plan  of  this  volume.  It  has  not  much 
connection  with  ordinary  causes  and  effects  of  indigestion.  It 
is  the  case  I  alluded  to  in  describing  the  expulsive  power  as 
"  relatively"  in  default. 

It  is  also  relatively  in  default  in  cases  of  hysteria  and  nervous- 


CONSTIPATION    AM)    COSTIVENESS.  273 

vhich  spasmodically  contract  the  sphincter  ani  and  rectum, 
at  the  fecal  mass  is  kept  back,  and  for  its  due  expulsion 
\v.»uld  be  required  a  more  than  ordinary  force,  which  in 
point  of  fact  is  not  likely  to  be  forthcoming  in  such  cases. 

And  not  uncommonly  a  catarrhal  state  of  the  upper  parts,  say 

of  the  stomach,  will  originate  a  relative  deficiency  of  expulsive 

power,  by  enveloping  the  alimentary  mass  in  a  slimy  coat,  so 

that  to  push  it  011  extraordinary  peristaltic  force  is  needed. 

But  the  most  common  case  is  an  absolute  deficiency  of  power 

1  by  a  weak  state  or  atony  of  the  colon.    This  is  a  state 

frequent  among  those  who  lead  a  sedentary  life,  the  anaemic, 

those  debilitated  by  long  acute  illness  or  confinement  to  bed, 

and  may  be  suspected  wherever  we  observe  a  pale  greasy  skin 

and  weak  limbs.    Old  people  very  frequently  suffer  from  it;  so 

icntly  indeed,  that  a  diminished  propulsive  force  in  the 

large  intestines  may  be  considered  as  a  normal  consequence  of 

advanced  age. 

class  of  persons  oftener  suffer  from  constipation  than  old 
MIS.  Their  sedentary  life  and  high  feeding  are  partly 
chargeable  with  their  liability.  But  in  addition  to  this,  the  en- 
demic diseases  of  the  country  are  often  the  exciting  cause,  and 
I  have  distinctly  traced  the  commencement  of  a  constipated 
habit  of  bowels  to  attacks  of  dysenteric  fever  brought  on  by 
malaria.  The  inflammation  of  the  colon  seems  to  leave  behind 
it  a  local  paralysis  of  the  part:  it  acts  in  fact  like  the  habit  of 
taking  artificial  purgatives.  So  that  the  Anglo-Indian  who 
suffers  in  this  way  must  not  be  always  accused  of  previous 
excesses  or  la/in- 

\,  -gleet  of  the  natural  call  to  evacuate  the  bowels  also  pro- 
duces this  sort  of  torpidity  by  too  long-continued  dilatation 
in  young  and  strong  persons.    This  neglect  of  the  natural 
call  may  be  from  lax:  ay  be  from  a  painful  condition  of 

the  evacuating  organs.    (See  CASE  CLXIIl.i 

Where  there  is  an  individual  tendency  to  atony  of  the  colon, 
is  aggravated,  and  sometimes  lirst  made  apparent, 
rtain  articles  of  diet.  My  those  which  contain  much 

•ible  matter.     It  is  a  mistake  to  suppose  that  these  "irri- 
the  bowels,  or  pass  quickly  through  them.     The  re\ 
is  true;  and,  as  a  general  rule,  the  regular  transmission  of  the 
L8 


274  CONSTIPATION    AND    COSTIVENESS. 

mass  is  in  proportion  to  the  completeness  of  its  digestion.  No 
sort  of  food  is  so  apt  to  be  followed  by  constipation  in  atonic 
persons  as  that  which  contains  a  large  amount  of  matter  inca- 
pable of  being  acted  upon  by  the  digestive  juices,  such  as  skin 
and  gristle,  the  husks  and  stones  of  fruit,  and  half-cooked  vege- 
tables, in  which,  besides  cellulose,  there  is  the  equally  imprac- 
ticable substance,  unbroken  starch.  All  substances  capable  of 
being  squeezed  into  a  tough  mass,  such  as  puff  pastry  and  new 
bread,  come  under  the  same  class  of  insolubles;  and  gum  and 
gelatine  are  liable  to  the  same  imputation  according  to  some 
observers. 

The  most  successful  practice  in  simple  constipation  is  the 
free  use  of  cold-water  enemata,  and'  a  long-continued  course  of 
Quinine  and  Strychnine.  When  there  are  no  piles,  this  may  be 
advantageously  combined  with  the  use  of  Aloes.  The  treat- 
ment does  not  forbid  the  administration  of  whatever  else  may 
be  needful  to  relieve  the  disease  in  which  constipation  occurs ; 
which  disease  of  course  requires  to  be  removed  before  the  local 
symptom  will  be  free  from  risk  of  relapse.  It  is  scarcely  neces- 
sary to  say  that  nothing  will  avail  if  the  bad  habits  which  have 
induced  the  constipation  are  persisted  in. 

If  there  be  piles,  the  introduction  into  the  rectum  of  a  greased 
rectum-plug  for  a  few  moments,  so  as  to  empty  them,  washing 
with  cold  water,  and  lying  down  on  the  back  for  ten  minutes 
after  evacuation,  give  great  relief. 

Constipation  may  often  be  much  alleviated  by  oleaginous 
articles  of  diet,  such  as  butter,  bacon,  &c.,  being  taken  with  the 
usual  food.  This  is  especially  the  case  with  old  people,  who  are 
apt  to  be  too  abstemious  in  this  respect.  We  should  not  fail  to 
impress  upon  them  the  physiological  fact  of  costiveness  being  a 
normal  condition  of  advancing  years,  and  lead  our  patients  to 
adjust  their  expectations  to  their  age.  They  must  not  demand 
from  sexagenarian  bowels  the  same  sensitiveness  that  is  due  at 
two-and-twenty.  Daily  evacuation,  which  should  be  the  rule 
in  youth,  is  an  excess  in  an  old  man,  and  still  more  in  an  old 
woman.  Thrice  a  week  is  enough  for  even  robust  persons. 

If  the  constipation  arise  from  impediments  to  the  movements 
of  the  bowels  upon  one  another,  such  as  adhesions,  scars  of  old 
ulcers,  compression  of  the  area  of  the  gut,  tumors,  retroversion 


CONSTIPATION    AND    COSTIVENESS.  27") 

of  the  uterus,  ami  the  like,  a  more  soothing  treatment  should  be 
adopted.  Then  the  enemata  should  be  warmed,  and  have  an 
ounce  of  olive  oil  added  to  them.  If  there  be  local  pain,  a  little 
Opium  may  be  dissolved  in  the  oil,  and  some  Leeches  applied 
to  the  spot  corresponding  to  the  seat  of  pain.  Hot  fomentations 
and  poultices  of  fresh  laurel  leaves  also  give  great  relief. 

The  depending  position  of  the  caecum  makes  it  the  com- 

monest   >«-at  ut'  fecal  collections;  and  if  it  is  found  difficult  to 

:i  any  other  spot,  it  is  wise  to  take  it  for  granted  that  this 

is  the  failing  one,  and  direct  our  local  applications  accordingly. 

We  should  not  be  satisfied  with  the  one  or  two  very  copious 

stools  which  will  follow  these  efforts;  the  treatment  must  be 

vered  in  until  the  bowel  has  recovered  its  tone,  or  there 

will  be  great  risk  of  relapse. 

When  there  is  much  flatulence  with  the  constipation,  Tur- 
pentine and  Rue  may  with  advantage  be  added  to  the  enemata. 

SECTION  II. 
Costiveness. 

In  costiveness  the  absolute  quantity  of  feces  is  always  too 
si) mil.  It  is  in  fact  a  deficient  excretion  into  the  alimentary 
canal. 

That  the  greatest  part  of  the  matters  which  ought  to  be  thus 
•  •ted  come  from  the  liver  we  have  not  the  means  of  knowing, 
but  the  main  point,  that  they  are  derived  from  portal  blood,  we 
are  justified  in  asserting;  so  that  the  solution  of  the  former 
question  is  of  the  less  importance.  And,  at  least,  that  a  great 
deal  of  the  color  of  feces  is  due  to  bile  we  may  know  from  the 
phenomena  attendant  on  obstructed  gall-ducts. 

11  when  there  is  complete  occlusion  of  the  communi- 
cation between  the  liver  and   intestines,  the   i'eces  by  no  means 
ntirely  of  undigested  ibod  ;  there  is  in  them  a  great 
proportion  of   yelhnvish-gray  granular  matter  which  appears 
in  the  healthy  Mate,  and  still  makes  up  the  bulk  of  the  solid 

In  deficiency,  therefore,  of  tin-  ftXOietive  pOWWH  of  the  intes- 
tine- generally  (rul,j,>  "  costiveness"   or   "biliousness").  th> 
a  diilerent  substance  retained  than  is  :  vhen  local  lesion 


276  CONSTIPATION    AND    COSTIVENESS. 

of  the  liver  or  gall-bladder  obstructs  the  passage  of  bile.  There 
is  a  partial  retention  of  the  whole  matters  destined  for  depura- 
tion from  these  quarters,  instead  of  a  complete  retention  of  one 
constituent. 

Hence  there  is  not,  as  happens  in  mechanical  retention  of  the 
bile,  the  well-known  stain  of  jaundice  communicated  to  the 
blood  and  skin,  nor  are  the  stools  clay-colored.  But  there  is 
a  dinginess  of  complexion,  and  the  stools  are  scanty.  The  skin 
is  greasy  and  opaque,  the  countenance  sometimes  puffy  and 
bloated,  sometimes  thin  and  pale,  the  lower  eyelid  especially 
sallow  and  discolored.  The  sebaceous  follicles  on  the  alse  nasi 
are  stopped  up  with  black  matter. 

There  is  seldom  any  decided  emaciation,  nor  is  there  always 
even  loss  of  muscular  power ;  but  still  there  is  great  sluggish- 
ness of  body  and  apathy  of  mind,  and  often  a  miserable  want  of 
decision  and  energy.  Digestion  is  accompanied  by  a  good  deal 
of  discomfort  and  flatulence,  but  rarely  by  actual  pain,  and  the 
distress  does  not  begin  till  several  hours  after  eating,  so  as  to 
be  with  difficulty  referred  to  any  particular  meal. 

In  the  least  complicated  cases  of  checked  intestinal  secretion 
the  stools  are  dark,  hard,  and  dry ;  but  their  appearance  may 
be  varied  by  several  circumstances. 

Sometimes  there  is  an  augmented  secretion  of  mucus,  and  then 
they  are  intimately  mixed  up  with  it,  forming  a  black,  slimy, 
almost  gelatinous  mass. 

Sometimes,  from  the  appetite  not  suffering,  the  patient  will 
eat  largely,  and  then  there  appears  irregularly  from  time  to 
time  a  quantity  of  fetid,  semi-digested  food,  constituting  a  sort 
of  diarrhoea  accompanied  with  pain  and  colic.  And  this  diar- 
rhoea will  often  be  the  occasion  of  your  patient's  first  coming 
to  you,  so  that  you  might  be  deceived  into  a  false  impression  of 
the  case. 

The  congestion  of  the  portal  vessels  in  the  upper  part  of  the 
alimentary  canal  is  often  followed  by  the  same  state  in  the 
lower,  and  thus  piles  are  formed,  which  add  much  to  the  general 
distress. 

Costiveness  is  a  common  accompaniment  of  anemia,  chlorosis^ 
and  debility  in  both  males  and  females,  of  diseased  hearts, 
especially  where  the  muscle  is  dilated  rather  than  hypertrophied, 


CONSTIPATION    AND    COSTIVENESS.  277 

of  contracted  liver,  and,  in  short,  of  anything  which  makes  the 
abdominal  circulation  sluggish.  Sometimes  it  is  found  in  c 
of  pulmonary  tuberculosis,  but  hardly  ever  in  consumptives 
under  middle  a<je.  In  their  old  age  it  may,  like  constipation, 
be  considered  the  normal  state  of  the  abdominal  viscera.  All 
those  pulmonary  cases  in  which  I  have  seen  it  last  long  enough 
to  be  a  marked  feature  have  been  examples  of  senile  phthisis. 
often  the  first  and  most  characteristic  phenomenon  of 
that  change  of  system  which  takes  place  in  females  after 
tion  of  the  catamenia.  The  stools  get  gradually  more 
and  more  scanty  as  the  uterine  secretion  diminishes,  as  the 
pulse  grows  feebler,  as  the  feet  and  hands  are  more  liable  to 
get  cold.  There  is  evidently  lessened  vitality  throughout  the 
whole  body. 

Habitual  constipation,  especially  if  it  be  habitually  attempted 
to  be  relieved  by  purgatives,  often  induces  costiveness.  The 
"bilious"  aspect  of  an  old  Indian  is  almost  proverbial.  You 
will  usually  find  these  persons  have  been  blue-pillers  from 
early  life. 

One  end  of  this  state  of  things,  if  left  unchecked,  is  gradual 
progress  from  bad  to  worse.     The  decrease  of  destructive  as- 
similation  loads  the  tissues  with  effete  matter,  useless  for  the 
purposes  of  life,  and  a  constant  source  of  general  discomfort. 
This  impedes  the  constructive  assimilation   of  food  as  well — 
growth  is  arrested,  the  blood  is  not  renewed,  and  hence  pro- 
-ive  amcmia,   weakness,   want   of  nervous   and   muscular 
r,  and  possibly  in  the  end  the  degeneration  of  one  or  more 
of  the  viscera,  and  death  from  that  c:t 

A  very  striking  attendant  on  the  loss  of  destructive  assimi- 
lation, is  the  depression  of  spirits  ;  melancholy  is  so  named  from 
the  dark,  scanty  stools,  which  were  observed  by  the  Greeks  to 
be  associated  with  it.  It  appears  to  me  to  be  an  almost  uni- 
•  1  rule  in  disease  that  the  general  discomfort  ia proportioned 
to  tli-  "f  this  vital  destruction,  and  I  am  inclined  to  at- 

tribute it  to  the  influence  on  the  nerves  of  general  sensation  of 
•matter  which  is  retained.  In  all  maladies,  both  acute  and 
lie,  may  l»i-  d  the  truth  of  this  law.  Mark  the 

ii-ln'rinu'  in  of  a  fever:  the  malai-  ve,  there  are  pains 

in  the  back,  in  the  head  and  the  limb-  -ense  of  what  the 


278  CONSTIPATION    AND    COSTIVENESS. 

patients  graphically  call  "  all  overishness ;"  but  when  they  get 
worse,  and  destruction  begins,  when  the  effete  matter  passes  off 
as  urea  and  increases  the  specific  gravity  of  the  urine,  then  no 
aggravation  of  local  symptoms,  however  much  it  may  alarm 
their  physician  and  make  his  prognosis  graver,  prevents  the 
general  feeling  of  relief.  Or  watch  a  case  of  consumption : 
the  deposit  of  tubercle  may  be  insignificant,  and  is  at  all  events 
in  its  first  stage,  yet  the  patient  is  despairing  of  recovery. 
Why  ?  Because  the  skin  is  sluggish,  the  bowels  costive,  the 
urine  of  low  specific  gravity  ;  because,  in  short,  there  is  retention 
of  effete  matter  in  the  system.  But  let  this  tubercle  soften  ;  let 
there  be  night  sweats,  copious  expectoration,  diarrhoea,  every- 
thing that  prophesies  ill,  and  who  so  full  of  hope  as  the  sinking 
sufferer  himself?  Morbid  states  where  destruction  is  in  excess 
are  the  most  fatal,  but  those  where  retention  preponderates  are 
invariably  the  most  distressing. 

Costiveness  must  be  regarded  as  a  disorder  of  the  whole  sys- 
tem, and  not  of  the  intestinal  canal  alone.  The  only  effectual 
remedies  are  those  that  are  advised  under  that  conviction. 

The  objects  of  treatment  must  be:  first,  to  relieve  the  body 
of  the  immediate  presence  of  effete  matter ;  and,  secondly,  to 
prevent  artificially  its  reaccumulation  till  such  time  as  a  com- 
plete renewal  of  the  tissues  has  taken  place.  Then  the  body 
ought  to  be  able  to  takfe  care  of  itself,  and  then,  and  not  till 
then,  a  cure  may  be  said  to  have  been  performed.  The  atten- 
tion to  local  disorders,  arising  from  the  successful  study  of 
morbid  anatomy,  has  too  much  made  us  forget  this  main  object 
of  all  medical  work — the  replacement  of  morbid  tissue  by 
healthy.  "Renew  my  age,"  was  the  chief  earthly  blessing 
prayed  for  by  the  inspired  prophet ;  and  physiology  teaches  us 
it  should  be  the  motto  of  the  rational  physician ;  for  if  he  omit 
to  rebuild  the  healthy,  his  care  for  the  destruction  of  the  un- 
healthy is  all  thrown  away. 

Purgatives  may  very  fairly  begin  the  treatment ;  for  the  im- 
mediate relief  they  give  to  the  feelings  of  discomfort  is  great. 
But  they  must  not  end  it.  And  let  not  the  relief  be  set  down 
to  the  mere  "  clearing  out  of  the  bowels ;"  it  is  the  cleansing  of 
the  blood  which  is  the  real  object  of  the  remedy,  and  the  real 
cause  of  the  relief.  An  inspection  of  what  comes  away  shows 


CONSTIPATION    AND    COST  I  V  K  X  K33.  279 

it  lias  been  newly  formed  ;  it  is  fresh  bile  and  other  natural  con- 
stituents of  recent  feces,  not  of  those  which  have  rested  long  in 
the  canal. 

Nothing  is  easier  than  thus  with  a  vigorous  Blue-pill  and 

Senna  draught   to  drive  away,  as  with  a   charm,  the  patient's 

and  he  is  ready  enough  to  cry  out  that  no  more 

medicine  is  -,vnnti>d.     But  what  is  the  consequence  of  leaving  off 

Mient  ?     The  renewal  of  the  blood  and  tissues  not  having 

ha<l  time  to  regain  its  original  activity — there  not  being  enough 

made  blood  to  carry  on  vigorous  life — the  effete  materials 

ajain  collect,  and  tip  'akes  a  fresh  starting-point.  A 

and  again  the  coarse  expedient  is  called  for,  and  at  last  fails  to 

•t  its  object  of  giving  relief. 

To  avoid  this  evil  consequence  it  is  best  to  give  no  quickly- 
acting  complete  purgatives  which  directly  deplete  the  abdominal 
plethora  by  serous  exudation;  but  rather  such  as  cause  a 
j_M-:ulual  increase  in  the  solid  matter  of  the  stools.  Aloes  and 
Khubarb  are  the  best  of  these;  and  I  find  it  also  beneficial  to 
combine  with  them  resins  which  act  as  a  tonic  to  the  surface  of 
the  mucous  membrane,  and  prevent  the  exudation  of  serum  and 
mucus..  Kour  -rains  of  Aloes-and-myrrh  pill,  every  night,  will 
in  a  week  produce  all  the  good  effect  of  strong  purgation ;  and 
it  will  produce  the  good  permanently  instead  of  merely  for  a 
lime. 

All  accessory  food  that  has  the   property  of  arresting  de- 
struction must  be  left  off.     Wine,  beer,  tea,  and  coffee,  must, 
on    this   account,   be  excluded  from   the   dietary ;   and   milk, 
>;i,    whey,  soda-water,   Seltzer- water,    &c.,    substituted   for 
them. 

1'erhaps  it  i.s  on  account  of  their  temporary  arrest  of  destrue- 

milation,   that  general   tonics,  such  as  Cinchona   and 

Quinine,  rarely  agree  well  in  those  cases.     I  find  it  better  to 

pure   bitters,   such    as    Oak-bark,   Quassia,   and    <ieiitian, 

which  seem  to  act  chiefly  on  the  mucous  membrane.     Their  use 

the  appetite;  and,  when   that  object  is  attain-  i.  I 

•  them  off;   or,  if  it   is  attained  without  them,  I   do    not 

in. 

Water  is  a  very  accessible  remedy,  and  certainly  a  very  ra- 
i  one,  when  the  destructive  asMiuilation  is  deficient.     The 


280  CONSTIPATION    AND    COSTIVENESS. 

conclusive  experiments  of  Dr.  Bockeraud  of  Dr.  Falck,1  show 
the  increase  of  all  interstitial  metamorphosis  by  this  agent  to 
be  in  close  proportion  to  the  quantity  taken,  within  certain 
bounds ;  and  all  who  have  heard  or  read  of  the  agreeable  sensa- 
tions experience  by  patients  during  the  water  cure,  cannot  doubt 
its  power  of  removing  morbid  accumulations  of  effete  matter  in 
the  tissues.  In  this  lies  its  strength  ;  for,  as  Dr.  Bocker  observed, 
"the  demand  for  new  tissue,  as  expressed  in  the  sensation  of 
hunger,  keeps  pace  exactly  with  the  extent  of  the  metamor- 
phosis." And  if  this  demand  is  rightly  supplied,  the  result 
must  be  a  complete  renewal  of  the  body. 

The  testimony  of  experience  to  the  use  of  water  as  a  reme- 
dial agent,  is  shown  in  the  patronage  bestowed  from  the  earliest 
times  upon  numerous  springs  whose  saline  constituents  are 
even  less  abundant  than  those  of  ordinary  drinking  water. 
Pfeffers,  historically  famous  for  freeing  Martin  Luther  of  his 
demon-haunted  hypochondriasis,  is  still  the  resort  of  the  invalid. 
It  is  situated  in  a  most  gloomy  hole ;  and  the  copious  hot  stream 
that  boils  out  of  the  rock  is  almost  chemically  pure.  So  that 
really  the  pure  warm  Yesta  of  the  fountain,  innocent  of  salt, 
should  have  the  whole  credit.  The  same  may  be  said  of  the  well- 
known  Gastein  and  Wildbad,  the  crowded  Baden,  imperial  Plom- 
bieres,  of  the  French  Aix,  and  our  own  long-frequented  Buxton? 
for,  practically  speaking,  the  influence  of  the  saline  particles 
they  contain  must  be  reckoned  for  nothing.  It  is  certainly 
nothing  as  compared  with  the  effects  of  moderate  doses  of 
water  in  Dr.  Booker's  experiments. 

As  physiologists  we  cannot  be  surprised  at  the  benefit  derived 
from  the  simple  expedient  of  drinking  water  beyond  the  demands 
of  thirst,  in  all  diseases  of  arrested  metamorphosis.  Taken 
several  times  a  day  between  meals  it  is  a  most  efficient  remedy. 
Warm  hip-baths  are  also  of  great  use,  and  can  be  borne  even 
from  the  first  by  those  reduced  to  extreme  anemia  and  lifeless- 
ness.  Afterwards,  the  cold  sponge-bath,  preceded  and  followed 
by  friction  to  the  skin,  is  a  most  active  promoter  of  life  in  the 
skin  and  capillaries.  The  raising  the  specific  gravity  of  the 
water  by  the  addition  of  salt  prevents  the  chill  which  fresh' 

1  See  "  Zeitschrift  der  K.  K.  Gesellschaft  der  Aertze  zu  Wien,"  April,  1854  ; 
and  Vierordt's  "  Archiv,"  i.  p.  150,  1853. 


CONSTIPATION    AND    COSTIVENESS.  281 

r  is  apt  to  impart.  So  that  even  persons  with  cold  hands 
and  feet,  and  very  sluggish  circulation,  indicated  by  weak  heart 
and  j mist's,  can  bear  to  be  sponged  with  sea- water  or  brine. 

Alkalies  and  neutral  salts  have  the  same  action  on  the  moult- 
ing of  effete  tissues  that  water  has.  Hence  the  repute  of  many 
reallv  strong  mineral  wells.  But  care  is  needed  lest  the  same 
t  should  follow  their  use  which  is  threatened  by  the  un- 
guarded use  of  purgatives.  In  cases  where  there  is  arrest  of 
•norphosis  without  organic  change  in  any  of  the  viscera,  I 
find  that  the  weaker  the  spring  the  better  for  the  patient. 

While  pulling  down  an  old  house,  we  must  remember  to  be 
building  up  the  new.  Let  full  supplies  of  albuminous  material 
be  continuously  kept  up  in  such  forms  as  the  absorbents  love. 
Let  rnilk,  mutton,  and  bread  be  the  staple  diet,  with  the  smallest 
quantity  of  anything  else  that  human  weakness  will  submit  to. 
If  the  patient  be  one  of  strong  mind,  the  best  and  bravest  thing 
him  to  carry  out  advice  himself.  He  will  then  have  gained 
a  vi.-tory,  not  only  over  the  flesh,  but  over  the  spirit.  But  if  he 
is  no  Stoic,  and  cannot  attain  to  the  dignity  of  being  his  own 
gaoler,  we  need  not  be  afraid  of  sending  him  to  a  hydropathic 
hotel.  A  little  pressure  will  induce  the  owners  of  these  houses 
to  carry  out  rational  directions,  and  the  situations  of  most  of 
them  are  well  chosen  for  the  advantages  of  air  and  amusement. 

Medical  men  sometimes  fear  that  in  sending  patients  to  water- 
cure  establishments  they  may  be  abetting  quackery.  In  my 
oj  tin  ion  scientific  hydropathy,  the  renewal  of  the  body  by 
T  and  food,  the  increase  of  growth  secondary  to  the  increase 
of  moulting,  is  very  far  from  quackery.  It  is  not  an  underhand 
mode  of  doing  nothing,  but  a  bond  fide  use  of  a  powerful  tool. 
And  therefore  a  contrary  effect  than  what  has  been  feared  would 
follow  ;  for  the  very  fact  of  medical  men  using  the  treatment  as 
remedial,  would  show  that  science  ranked  it  as  a  genuine  phy- 
sical power;  and  that,  consequently,  it  is  capable  of  doing  as 
much  harm  as  it  docs  <_'ood  :  in  fact,  that,  like  all  medical  treat- 
ment, it  needs  as  much  prudence  to  prescribe  it  rightly  as  the 
powerful  agent  in  the  phannaoopOBUL  Its  being  thus 
adopted  by  regular  practitioners  would  soon  remove  it  out  of 
the  hands  of  advertisers,  who  discredit  their  really  valuable 
wares,  by  attributing  to  them  impossible  powe 


282 


CHAPTER   IX. 

NERVE  DISORDERS  CONNECTED  WITH  INDIGESTION. 

Headache  and  Hemicrania — Vertigo — Loss  of  control  over  the  thoughts — Epi- 
lepsy— Chorea — Stomach  cough — Anaesthesia  and  Paralysis — Atrophy  of  mus- 
cles— Flushing  of  face  and  Nettle-rash. 

THE  most  common  morbid  affection  of  the  nervous  system 
arising  from  imperfect  digestion  is  HEADACHE.  The  conse- 
quences of  a  debauch  in  a  person  unused  to  it  are  quite  as  often 
splitting  and  throbbing  of  the  temples  as  "hot  coppers"  and 
nausea.  It  is  not  usual  to  consult  a  physician  for  such  an  occur- 
rence, and  therefore  I  have  no  illustration  to  quote.  It  has  been 
suggested  that  the  state  of  the  stomach  is  dependent  on  the  state 
of  the  brain,  which  is  poisoned  by  the  presence  of  absorbed 
alcohol,  and  secondarily  causes  the  vomiting  just  as  cerebral 
tumors  and  inflammations  do.  I  cannot  agree  with  that  view 
of  the  matter,  because  certainly  we  find  headache  accompanying 
derangements  of  the  stomach  which  are  not  the  result  of  alcohol. 
Instances  are  given  in  CASES  XIV  and  XXXI  where  the  com- 
parative overlading  the  stomach,  that  is  lading  it  with  more 
than  in  its  weakness  it  was  able  to  bear  of  vegetable  food,  brought 
on,  each  time  separately,  severe  headache.  In  CASE  XXXVIII 
indigestion  of  meat,  and  in  XLV  indigestion  of  fat,  brought  on 
headache  on  each  occasion.  In  these  last  two  it  was  followed 
by  constipation,  but  that  is  not  invariably  the  case.  The 
'•bilious  attacks"  also,  as  depicted  in  CASES  CLXVIII,  CLXIX, 
headache  is  a  familiar  accompaniment  of  the  acute  gastric 
catarrh.  This  may  be  viewed  as  the  acute  form  of  the  compli- 
cation. 

A  more  chronic  form  is  exhibited  in  the  following : — 

CASE  CCXXXI. — Rev.  T.  S —  has  been  an  occasional  patient  of  mine  since 
1860,  when  he  was  45  years  old,  a  confirmed  bachelor  contented  with  his  lot 


NERVE    DISORDERS.  283 

and  quite  disposed  to  a  rational  enjoyment  of  life.  He  had  had  gout  in  early 
manhood,  and  lived  temperately  by  rule  to  avoid  a  recurrence.  But  he  had 
an  anxious,  easily  worried  mind,  and  the  occasion  of  his  coming  to  consult 
m>'  was  the  occurrence  as  often  as  twice  a  month  of  intense  headaches,  lasting 
several  days.  They  occupied  the  whole  head,  obscun-d  tlie  sight,  and  ren- 
dereil  him  unfit  for  his  dericul  duties  during  the  paroxysms.  I  found  that 
each  attack  was  preceded  l>y  irastric  symptoms,  complete  anorexia,  and  some- 
tiin>'s  by  vomiting.  A  holiday  trip  to  the  seaside,  when  the  cares  of  the 
parish  were  forgotten  in  boating,  sketching,  riding,  and  society,  entirely  re- 
lieved them  and  kept  them  off  for  many  weeks  afterwards.  After  each  attack 
he  was  used  to  have  pain  in  the  anus  and  urethra,  and  pain  on  passing  urine, 
which  was  acid,  and  deposited  copious  clouds  of  lithates  on  standing. 

iiir-continued  course  of  non-purgative  doses  of  Taraxacum,  the  habitual 
use  of  Potash-water  as  a  drink  at  dinner,  and  some  occasional  short  courses 
of  (v>i.inine,  have  made  M  r.  S—  a  much  stronger  and  heartier  man,  and  relieved 
him  from  the  dominion  of  his  headaches.  It  is  possible  too  that  he  takes  the 
world  easier  as  he  trets  older,  and  being  convinced  of  the  evil  consequences 
of  worry,  avoids  it  more. 

Sorry  should  I  be  to  advocate  selfishness,  yet  truly  it  has  a 

rd  in  this  life,  by  preventing  the  stomach  being  disturbed 

by  the  business  of  others.   In  such  cases  as  the  above  one  cannot 

avoid  seeing  that  the  path  of  events  is  first  the  arrest  of  the 

ic  digestion  by  the  accumulating  influence  of  over-thought 

on  the  stomach,  and  by  this  latter  organ  retaliating  on  the  brain 

to  disable  its  functions.     It  seems  a  fair  application  of  the 

nis. 

The  gouty  constitution  of  the  patient  shows  him  to  have  a 
Aveak  sensitive  stomach,  easily  put  off  work,  and  unable  at  such 
times  to  bear  its  ])<•<•. v^iry  load.  The  alkaline  drink  probably 
ioted  the  secretion  of  gastric  juice,  and  the  Taraxacum  the 
secretion  of  bile,  but  I  question  if  such  remedies  can  be  trusted 
to  alone,  as  I  liave  remarked  in  the  preceding  chapter.  Nerve 
tonics  are  needful  to  complete  a  cure. 

The  mental  causes  acting  on  the  stomach  need  to  be  very 
slight  in  weakly  excitable  temperaments,  such  as  women  have. 

-uCCXXXII.— Mrs.  James  R— ,  aged  39,  came  to  me  in  May.  lsi',1. 
She  was  married,  but  childless,  thouirh  the  catamenia  were  copious  and  regu- 
lar. About  every  fortnight  the  slightest  annoyance  or  bodily  fatigue  brought 
en  n:iu.-i-a.  loss  of  appetite,  and  a  throhliin;:  i"  the  teiii|»l"s.  This  was  gene- 
rally  in  the  evening,  and  the  next  morning  after  a  restless  night  she  awoke 
with  an  intense  headache,  so  that  she  could  not  raise  her  neck  from  the  pillow. 


284  NERVE    DISORDERS 

This  lasted  till  next  night,  and  then  went  away,  almost  always  suddenly,  and 
she  found  herself  quite  well  without  any  abnormal  evacuation.  I  gave  her 
Steel  wine  after  food,  and  the  intervals  of  the  headaches  seemed  to  grow 
longer ;  but  I  only  saw  her  twice  afterwards,  and  do  not  know  if  she  were 
entirely  cured. 

CASE  CCXXXTTI. — Miss  H — ,  a  red-faced,  dairymaidish  woman  of  40,  had 
thrown  upon  her  the  charge  of  a  large  inn  in  a  market  town,  where  she  was 
kept  going  all  day  among  farmers  and  troublesome  barmaids  in  consequence 
of  the  difficulty  I  found  in  curing  her  father  of  rheumatic  gout,  so  as  to 
enable  him  to  take  his  share.  She  could  get  on  very  fairly,  were  it  not  for 
attacks  of  sickness  and  fluttering  at  the  epigastrium,  accompanied  or  followed 
by  intense  headaches  at  night,  so  severe  as  to  awaken  her  up  out  of  sleep  with 
pain.  Otherwise  the  bodily  functions  were  healthily  performed. 

She  came  to  me  April  19th,  1861,  and  I  gave  her  Iodide  of  Potassium  and 
Tincture  of  Sesquichloride  of  Iron. 

I  saw  her  again  on  May  6th,  when  she  said  her  haad  was  much  better  since 
the  last  prescription,  but  that  her  legs  were  swelled.  On  inspection,  this 
proved  to  be  due  to  lumps  of  Erythema  nodosum.  I  then  gave  her  Citrate 
of  Quinine  and  Iron.  She  went  on  with  this  some  weeks,  and  was  quite  well 
as  long  as  she  took  it ;  but  on  leaving  it  off  her  headaches,  &c.,  relapsed,  and 
she  came  up  to  London  again  about  them.  So  I  desired  her  to  take  Sesqui- 
oxide  of  Iron  with  her  daily  food  as  long  as  the  untoward  exertion  of  mind 
and  body,  to  which  she  was  exposed,  lasted.  This  seems  to  have  been  effectual. 

I  have  cited  this  last  case  for  the  sake  of  noticing  by  the  way 
the  connection  of  Erythema  nodosum  with  gastric  derangement. 
It  is  so  connected  mostly  in  cases  where  the  nervous  system 
suffers.  Thus  we  shall  find  that  hysterical  women  are  subject 
to  that  cutaneous  affection,  especially  when  the  hysteria  is  due 
to  the  stomach. 

In  these  last  two  cases  I  ordered  Iron,  but  I  do  not  think  it 
such  an  important  agent  as  Quina,  which  in  the  second  pre- 
scription of  the  two  I  have  joined  with  it.  However,  the  Iron 
did  not  disagree,  even  in  the  red-faced  and  apparently  red- 
blooded  patient.  Indeed,  where  we  see  other  evidences  of  need 
for  tonics,  our  diagnosis  of  the  anaemic  condition  of  the  blood 
by  the  color  of  the  face  must  be  very  guarded.  The  tint  of  the 
inside  of  the  lips  is  a  safer  guide. 

The  frequent  occurrence  of  instances  like  these,  where  a 
mental  responsibility  which  to  a  man  would  be  a  flea-bite^ 
overwhelms  a  woman,  should  be  a  caution  to  those  who  are 
desirous  of  equalizing  the  brain-work  of  the  two  sexes. 


CONNECTED    WITH    INDIGESTION*.  285 

It  was  mentioned  in  CASK  X  X  XI  that  the  patient  was  fearful 

of   "apoplexy"   from  the  giddiness  which  accompanies  these 

headaches.    Such  a  fear  doubtless  makes  the  nervous  symptoms 

•1  it  ought  to  be  dispersed  by  all  possible  means  con- 

,t  with  truth.     The  idea  is  not  confined  to  bad  observers, 

but  was  exhibited  in  the  following  instance  by  a  medical  man. 

(•(XXXI  V  .—Nov.  29th,  1866.— H.  W— ,  aged  47,  a  country  surgeon, 
who  has  inherited  and  kept  up  a  first-class,  steady  practice,  has  become  lately 
anxious  about  his  health,  and  he  is  fearful  of  apoplexy,  of  which  his  father 
died.  So  that  he  thought  even  of  disposing  of  his  practice.  What  causes 
hi-  anxiety  is  that  at  least  every  month  he  has,  generally  the  day  after  some 
unusual  mental  exertion,  an  attack  of  violent  headache.  It  begins  at  day- 
break, and  gets  rapidly  worse,  so  that  he  is  unable  to  get  up,  indeed  can 
hardly  raise  his  head  from  the  pillow.  It  is  accompanied  with  great  nausea, 
but  rarely  with  vomiting,  and  goes  off  rather  suddenly  in  about  forty-eii:ht 
hours.  His  tongue  is  pale  and  flabby,  the  pulse  beats  soft  and  rather  quick- 
end  he  notices  that  of  late  his  complexion  has  grown  paler  and  that  he  is 
yellower  "  about  the  gills." 

Ordered  to  take  2  grs.  of  Quinine  and  ^th  of  a  grain  of  Strychnia  twice  a 
day.  In  case  of  being  surprised  by  a  headache  to  take  2  drachms  of  Ammo- 
uiated  Tincture  of  Valerian  every  three  hours  till  it  disperses.  To  avoid  all 
purgative  drugs,  to  drink  light  Burgundy,  and  at  dinner  only.  By  all  means 
t«>  persist  in  following  his  profession,  and  to  take  interest  and  pleasure  in  it. 

I  lieard  from  a  patient  of  his  in  March,  1867,  that  he  had  become  quite 
well  and  easy  about  his  health. 

The  counsel  to  the  above,  to  continue  the  practice  of  his  pro- 
on,  was  given  with  a  view  of  avoiding  the  hypochondriasis 
aii'l  stomach  derangement  often  thereon  consequent,  which  so 
often  is  produced  by  forsaking  an  active  life  for  idleness. 

The  Valerian  was  designed  as  a  temporary  relief  only,  the 
ba.-ie  treatment  being  Quinine  and  Strychnine  with  the  hygienic 
measures  detailed. 

That  such  treatment  will  cure  even  very  obstinate  headache, 
deeply  ingrained  l>y  time,  is  shown  by  the  following  narrative: — 

1  '  '   \  \  \  V  — A   very  respectable   licensed  victualler,  aged   44,  of 

moderate  and  regular  married  habits,  was  introduced  to  me  by  his  medi<  al 
man.  I»r.  Slight.  I'e'-.  L'l-t.  iHiG.  For  more  than  cL'ht  years  he  had  .-u  tie  red 
from  sick-headache*.  They  used  to  come  on  once  in  six  weeks,  but  had 
n  gradually  worse  and  more  frequent,  so  that  then  lie  was  never  a  fort- 
night without  an  attai-k.  lie  almost  always  has  warning  of  its  approach  two 
or  three  days  beforehand  conveyed  by  hi-  frauds  noticing  an  unusual  bright- 


286  NERVE    DISORDERS 

ness  and  clearness  of  his  eyes.  Then  the  day  before  he  feels  a  giddiness  in 
the  head  and  a  coldness  of  the  extremities.  Then  at  night  or  in  the  early 
morning  on  comes  the  headache  so  bad  that  he  cannot  raise  his  head  from  the 
pillow,  much  less  get  up  to  business.  This  continues  till  he  vomits,  which 
brings  immediate  relief.  He  had  taken  at  various  times  much  Pilula  Hydrnr- 
gyri,  but  latterly  Dr.  Slight  had  very  properly  substituted  Podophylliu  for 
that  "  blue  ruin"  to  chronic  disease. 

I  continued  in  the  same  spirit  the  alteration  in  the  treatment  by  giving  him 
Aloes  and  Myrrh  for  a  few  days  only,  and  then  leaving  off  purgatives  alto- 
gether. I  prescribed  also — 

R. — Quiniae  Sulphatis  gr.  xl, 

Succi  limonum  recentis  q.  s.  ad  illam  solvendam, 
Tinct.  Valerians  flsiiss, 
Aquae  ad  Oj. 
Coch.  ij  max.  ter  die. 
R. — Tinct.  Valerian*  Ammoniatae, 

Coch.  ij  min.  in  aqua  soluta  sumantur 

alterna  quaque  hora  imminente  cephalalgia. 

On  February  20th,  1867,  I  was  informed  by  Dr.  Slight,  who  came  to  me 
about  other  business,  that  our  patient  was  much  improved,  and  that  he 
thought  he  was  getting  quite  well. 

On  March  4th  I  saw  him.  He  had  just  had  one  paroxysm  of  the  bad  sick- 
headache,  but  that  was  the  only  one  since  Dec.  21st.  He  had  however  fre- 
quently headaches  of  a  hemicranic  character  of  a  morning,  which  are  relieved 
by  a  cup  of  strong  coffee. 

Thinking  his  constitution  might  be  becoming  too  habituated  to  the  Quinine, 
I  changed  it  for  the  Quinias  et  Ferri  Citras,  of  which  he  was  to  take  six 
grains  twice  a  day. 

Since  then  he  has  been  free  from  headache  (April  6th). 

The  pain  in  the  last  case  is  described  as  HEMICRANIC  when 
getting  better,  so  I  presume  that  when  that  peculiarity  occurs 
that  the  prognosis  may  be  considered  more  favorable  than  when 
it  persists  all  over  the  cranium.  In  the  ensuing  instance  again 
there  was  hemicrania,  and  it  may  be  described  as  a  mild  curable 
case. 

CASE  CCXXXVI. — James  C —  has  been  a  frequent  patient  of  mine  since 
early  in  1861,  when  he  was  a  widower  of  60  years  of  age.  Thirty  years 
previously  he  had  rheumatic  fever  and  inflammation  of  the  heart,  the  remains 
of  which  are  discernible  in  an  irregular  pulse,  a  sharpish  beat  in  the  heart 
and  a  systolic  murmur.  He  had  an  appointment  affording  him  the  blessing 
of  regular  occupation,  but  latterly  he  had  found  himself  growing  unequal  to  the  ' 
mental  calls  upon  him.  Any  unusual  exertion  brought  on  six-headaches, 
beginning  with  dizziness  and  oppression  at  the  vertex,  but  usually  fixing  on 
one  side  or  the  other,  and  ending  with  vomiting. 


CONNECTED    WITH    INDIGESTION.  287 

This  was  invariably  the  case  if  he  went  too  long  without  food.      \ 
often  a  heudai -he  would  begin  before  breakfast,  but  if  he  could  manage  to  eat 
•ial  HUM!  it  would  go  oil'. 

Sometimes  in  the  intervals  of  the  headache  he  was  much  troubled  with 
Mttleraab. 

1  had  him  leeched  at  the  back  of  the  neck,  and  I  afterwards  gave  him 
Citrate  of  (Quinine  and  Iron ;  but  what  I  found  did  most  good  was  the  advice 
never  as  much  as  four  hours  without  food.     He  convinced  himself  by 
experience  this  was  the  best  treatment. 

In  the  autumn  he  took  it  into  his  head  to  marry,  and  that  brought  back  a 
relapse  of  headaches.  But  a  return  to  his  former  treatment  took  them  away, 
and  he  is  still  able  to  go  on  with  his  occupation — at  least  he  was  so  able  when 
I  last  saw  him  in  the  spring  of  1866. 

Kemark  the  nettlerash,  a  near  relation  of  Erythema  no>.los  >/,//, 
aft'ecting  the  same  habits.  I  feel  sure  both  these  cutaneous 
disorders  originate  in  the  stomach,  and  are  propagated  to  the 
surface  by  a  sensitive  nervous  system. 

I  am  sorry  I  had  him  leeched ;  it  was  a  foolish  concession  to 
the  opinion  of  another. 

( >n  the  other  hand,  when  sick-headaches  are  growing  worse 
they  seem  usually  to  occupy  the  whole  head,  or  the  bade  j>art 
of  the  head,  as  described  in  the  history  given  by  the  next. 

X  X  X  V 1 1.—/-*,  l.rimry  23d,  1867.— Mr.  W.  S— ,  aged  44,  a  dork 
•ieiitary  habits,  was  always  very  well   till  eighteen  months  ago.  never 
suffering  from  anything  except  occasional  piles,  so  usual  in  sedentary  men. 
At  about  that  period  he  began  to  have  sick-headaches,  which  now  occur  at 
i -nee  a  fortnight.     They  be^in  with  what  he  calls,  basing  his  nomencla- 
ture I  suppose  on  some  false  medical  theory,  an  attack  of  "liver:"  that  is  to 
say  1,  -  appetite,  and  can  eat  nothin.i:  from  nausea  and  disgust   tor 

two  d:i\-.  II'-  then  becomes  prostrate,  has  a  ••  grasping  pain"  at  tin-  back  of 
the  head,  and  in  the  ri.uht  hypochondrium.  The  urine  becomes  dark  and 
hk'h-colored.  and  then  thick. 

I'ur.L'atives  had  been  prescribed  for  him  in  a  hope  of  warding  off 
attacks,  and  in  consequence  the  bowels  had  become  exceedingly  cocti 
as  to  .-cciii  to  re'piire  a  continued  use  of  such  drugs, 
li.— (tM]iiiia-  Sulphatis  trr.  ij. 

Strychnia:  hydrochloratis  <rr.  ;'<,, 

in  succo  limonis  et  c<|iia  soluta  bis  die  sumantur.  Omittantur  alia  medi- 
oamenta. 

My  objection  to  JIM:  \t  that  not  only  do  they  make  the 

bowels  costive  and  become  a  habit  difficult  to  leave  niV,  but 


NERVE    DISORDERS 

that  they  really  increase  the  frequency  of  the  disease  they  were 
prescribed  for.  In  the  following  case  it  seems  to  me  that  a  dis- 
tinct history  of  continuously  growing  disease  from  the  continu- 
ance of  purgative  habits  is  afforded. 

CASE  CCXXXVIIL— W.  G.  R— ,  aged  26,  has  never  been  strong,  and 
comes  of  a  delicate  family,  his  mother  having  been  a  great  sufferer  from 
derangements  of  the  digestive  organs.  Since  boyhood  he  has  suffered  from 
headaches,  which  have  been  growing  steadily  more  frequent,  so  that  for  three 
months  there  has  been  hardly  ever  a  day  without  one.  His  habits  are  these 
— he  goes  to  business  after  breakfast ;  at  half-past  one  he  dines  ;  at  three  in 
the  afternoon  a  sort  of  "  hard  feeling"  in  the  stomach  comes  on,  and  nausea ; 
in  a  short  time  this  turns  to  a  headache,  with  pain  over  both  eyes  and  in  the 
temples.  He  then  takes  a  pill,  which  acts  by  half-past  nine.  He  goes  to 
bed,  and  the  headache  passes  away  during  the  night.  If  it  lasts  till  the  mor- 
row, he  takes  a  fresh  purgative.  After  such  a  history  it  is  almost  needless 
to  add  that  he  has  got  much  thinner  during  the  past  year,  and  that  his  urine 
is  frequently  thick,  showing  the  imperfect  vitality  of  the  kidneys.  What  he 
brings  with  him  is  clear,  of  the  specific  gravity  1.015,  acid,  and  not  albumi- 
nous. 

March  8,  1867. — Ordered  him  a  grain  and  a  half  of  Quinine  and  5'2d  of  a 
grain  of  Strychnine  twice  a  day  for  three  weeks,  and  every  night  for  a  week 
three  and  a  half  grains  of  Aloes  and  Myrrh  pill. 

April  15,  1867. — Mr.  R —  reports  that  he  took  the  medicines  for  ten  days, 
and  found  himself  so  much  improved  that  he  left  them  off.  Then  he  found 
himself  falling  back  gradually,  and  began  them  again,  and  is  again  progress- 
ing most  favorably.  His  bowels  are  open  now  without  the  Aloes.  I  have 
ordered  him  Citrate  of  Iron-and-Quinine  as  a  change. 

It  will  be  seen  that  in  such-like  cases  I  am  disposed  to  attri- 
bute the  costiveness  to  the  disease,  rather  than  the  disease  to 
the  costiveness.  I  believe  strong  purgatives  to  be  highly  inju- 
rious, and  those  only  permissible  which  increase  the  tone  of  the 
alimentary  canal,  and  render  it  more  disposed  to  continue  its 
action  without  help  than  to  require  additional  help  as  time 
goes  on.  Of  such  sort  is  Aloes. 

The  phenomenon  of  sick  headache  is  closely  connected  with 
GASTRIC  VERTIGO,  the  next  nervous  symptom  arising  from  indi- 
gestion which  I  propose  to  sketch. 

CASE  CCXXXIX. — R.  N — ,  aged  26,  a  melancholy,  weather-beaten  young 
man,  first  consulted  me  June  12th,  1866.  He  had  been  educated  as  a  sculpv 
tor.  but  had  lived  a  roving  life,  had  made  an  expedition  into  the  Central 
wilds  of  Australia,  anJ  otherwise  knocked  about  the  world  a  good  deal.  In 


CONNECTED    WITH    I  X  DIG  ESTI  0  X.  289 

•rests  he  had  been  subjected  of  coarse  to  great  privations,  supporting 

in--  tini.-  iiKiiuly  on  tea  and  tobacco  ;  and  seemingly  in  conse- 

quence of  th*1  the  Teiaa  of  his  leg*  and  thi»hs  bad  grown  varicose.    He  wished 

<>n  tl:  to  forsake  the  plastic  art  and  take  to  painting,  as  requiring 

•.Hiding,  and  giving  wider  scope  for  inventive  genius,  of  which  he  has  a 

lhare.     He   had    from   boyhood  been  subject   to  sick-headaches,   and 

had  Keen  used  to  be  purged  for  them.     The  purgatives  seemed  to  relieve  im- 

mediate discomforts  ;  but  he  thought  the  attacks  were  thereby  aggravated. 

•  •me  latterly  more  and  more  severe  and  frequent;  and  they 

::.panied  l>y  such  giddiness  that  he  was  unable  to  stand  or  to 

employ  his  mind  at  all.     Bright  globes  rolled  before  his  eyes,  and  any  attempt 

•••  brought  on  nausea  like  sea-sickness.     This  was  occurring  every  ten 

..:  I'-a-t.  and  he  was  so  evidently  an  invalid,  that  a  marriage  he  was  on 

the  point  of  contracting  was  objected  to  by  the  intended«father-iu-law  on  the 

"f  his  ill-health. 
The  purgatives  had  made  his  bowels  very  irregular  and  costive. 

re  him  first  four  grains  of  Aloes  and  Myrrh  pill  with  2'0th  of  a  grain  of 
Hydrochlorate  of  Strychnia  nightly.  and5ij  of  Ammoniated  Tincture  of  Va- 
lerian thrice  a  day.  After  a  fortnight,  during  which  he  was  free  from 
the  pill  was  diminished  to  two  and  a  half  grains  of  the  first  ingre- 
dient and  z'4th  of  a  grain  of  the  latter.  The  Valerian  was  exchanged  for 
(.^iiin 

•>v  him  several  times  in  July.     He  had  but  one  slight  attack  of  ver- 
he  had  been  able  to  leave  off  the  pills,  as  the  bowels  were  spontaneously 
1  by  solid  feces  daily  after  breakfast.     I  recommended  him  now  to  go  to 
a  good  surgeon  and  have  his  legs  attended  to. 

In  October  I  found  he  had  continued  well  till  he  had  his  varicose  veins 

.  !ed  upon,  and  then  the  pain  and  distress  of  the  operation  (which  was 

,1)   laid  him    up  again  with  his  old  vertigo  and  headache. 

Hut  a  week's  Strychnine  and  Quinine  set  him  up  again.     I  recommended 

him  in  future  to  take  his  course  of  the  same  medicine  the  first  ten  days  in 

i  month. 

Again  in  this  case  it  will  be  seen  that  purgatives  made  the 
patient  worse. 

I  think  this  functional  disturbance  of  the  brain  is  especially 
frequent  when  the  indigestion  tak  Tin  of  intestinal  flatu- 


•'•nt  lady  of  :>•_>.  fir^t  came  to  me  in  May.  1868. 
She  had  lost  her  husband  thre.-  ioii-ly.  ju-t  at  the  period  of  ti, 

i.  it  time  had  sutl'ered  from   indigestion  111 

various  forms.      Latterly  she   had  been    miirh  alarmed  by  the  occurrence  of 

frequent  attacks  of  giddiness  ;  and  her   son.  a  medical   man,  thought  these 

miirht    be  due   to    di-'-;i---d  heart.      I  found   these  attacks  of  giddiness  were 

-  coincident  with  the  rolling  of  wind  about  in  the  bowels,  that  they  were 

19 


290  NERVE    DISORDERS 

relieved  when  it  passed  away,  and  were  also  relieved  by  a  strong  purgative 
though  they  came  on  worse  again  after  its  action. 

The  administration  of  Valerian  and  Charcoal  always  does  this  patient  good, 
but  I  have  never  seen  her  lately. 

This  very  frequent  degree  of  giddiness  has  been  explained  as 
a  sort  of  drunkenness,  caused  by  the  absorption  of  alcohol 
evolved  by  the  fermentation  of  sugar  in  the  alimentary  canal. 

But  there  are  several  reasons  against  that  explanation.  First, 
in  producing  alcohol  capable  of  intoxicating  an  adult,  say  five 
or  six  ounces  at  least,  a  bulk  of  carbonic  acid  would  be  formed 
enough  to  burst  the  bowels  all  to  bits.  Whereas  in  fact  they 
are  dilated  only  to  the  extent  of  a  few  cubic  inches. 

Again,  when  we  see  that  fermentation  has  been  going  on  in 
the  stomach,  as  in  certain  catarrhal  conditions  of  the  organ  with 
the  tendency  to  parasitic  growth  mentioned  in  a  former  chap- 
ter, we  do  not  find  as  a  rale  any  remarkable  giddiness  com- 
plained of. 

Again,  the  breath  is  not  scented  with  alcohol,  as  it  probably 
would  be  were  much  alcohol  absorbed. 

Again,  the  symptoms  are  not  all  like  those  of  drunkenness. 

In  respect  to  the  last  observation,  it  is  true  that  inexperienced 
persons,  such  as  the  estimable  lady  last  quoted,  may  sometimes 
tell  their  physician  that  they  feel,  when  giddy,  as  if  they  had 
been  "  taking  too  much"  (alcohol) ;  but  the  more  habitual 
devotee  knows  the  difference  of  the  two  sensations,  and  draws  a 
broad  line  between  them. 

CASE  CCXLI. — Herr  V.  J — ,  aged  30,  a  musician  and  teacher  of  music, 
consulted  me  in  June,  1866,  concerning  a  peculiar  kind  of  giddiness,  which 
would  seize  him  at  all  sorts  of  inconvenient  times,  and  quite  disqualified  him 
for  the  exercise  of  his  profession.  He  would,  in  going  through  the  streets  in 
a  hurry  to  keep  an  appointment  with  a  pupil,  suddenly  become  so  giddy  and 
blinded  that  he  tumbled  against  passengers,  and  was  forced  to  catch  hold  of 
neighboring  railings  for  support.  Yast  dusky  globes  of  mysterious  gloom 
rolled  before  his  eyes,  he  lost  sight  of  the  ground  before  him,  so  that  a  billowy 
gulf  yawned  under  his  feet,  and  he  swayed  helplessly  on  the  brink.  It  was  a 
continual  renewal  of  the  punishment  of  the  company  of  Korah.  "  Haven't 
these  symptoms  some  connection  with  your  indulging  in  the  gifts  of  Bacchus 
as  well  as  singing  their  praises  ?"  "  No,  indeed— no  one  knows  better  than  I 
do,  I  am  sorry  to  say,  the  effects  of  taking  too  much  ;  but  this  is  quite  different; 
it  is  nothing  like  either  being  screwed  or  t/e </•/<"«  Iri-ntbles."  (The  medical 


CONNECTED    WITH    INDIGESTION.  291 

will  identify  liy  its  initials  the  scientific  name  of  the  disease.)     He  said 
iv  became  !>!<>wn  out  with  exbOMive  flatulence;  if  he  could  explode,  all 
11 :  hut  if  not,  then  the  ulmve-mentioned  symptoms  supervened.     Some- 
time, however,  vomiting  would  relieve  him:  and  if  he  had  a  succession  of 
the  attacks,  a  stout  drench  brought  temporary  alleviation.     He  said  he  had 
taken  much  and  various  purgative  medicine  for  this  purpose,  and  felt  sure 
that  the  general  effect  afterwards  was  deleterious. 

('('XI. II. — Another  patient,  A.  W — ,  whom  I  saw  in  consultation 
with  Mr.  Hewer  in  April,  1867,  and  where  the  intestinal  flatulence  ow> 
origin  \e  bloodletting  alter  some  sort  of  fit  long  ago.  complained  to 

in.-  that  the  irround  seemed  to  lie  ;•/>///;/  Ixhiiul  him  as  he  walked,  so  that  he 
.  on>taiit  fancy  that  he  was  going  to  be  overwhelmed.     This  was  a  sen- 
i  unt  dis>imilar  to  that  noticed  by  the  last  two. 

( >nce  a  shrewd  fellow  made  a  quaint  play  of  words  describing 
the  connection  of  the  brain  and  the  stomach,  which  may  serve 
as  a  reminder  of  the  fact. 

X  I.I  1 1. — Mr.  II — ,  a  railway  traffic  manager  of  40,  complained  to 
me  in  September,  1862,  that  for  seven  years  he  had  suffered,  from  the  frequent 
occurrence  of  very  fetid  stools,  unformed  and  pultaceousj  passed  usually  in 
the  morning  on  first  rising  with  a  little  griping.  What  most  annoyed  him  was 
at  these  times  he  experienced  great  difficulty  in  transacting  business  requiring 
attention;  the  amount  of  fetor  in  the  stools  was  an  inverse  measure  of  the 
mental  powers;  us  he  expressed  it,  "the  addled  eggs  in  the  motions  addled 
the  brain." 

!!•  o  dine  in  the  middle  of  the  day,  and,  I  think,  derived  some 

benefit  from  my  advice  to  him  to  postpone  the  heavy  meal  till  evening.     Ipe- 
..nlia  and  Opium  also  seemed  of  use  to  him. 

The  confusion  of  thoughts  usually  comes  over  the  subject  of 
it  just  at   the  very  times  when  it  is  most  inconvenient;  and  it 
rhis  iliiVerence     from    hysteria,  that  the  more  exertion  is 
uuul'  .irol,  the  worse  it  grows. 

<  VX  1.1  V.—  A  tutor  of  a  large  and  rising  college  at  Oxford,  aged  •_'•'.. 
in  March.  1  Mil  .was  frightened  by  the  unaccii>tomed  occurrence  of  trembling, 
and  u  tendency  to  lose  the  recollection  of  his  whereabouts  during  divine 
service  a  circtim>tan<  e  most  particularly  annoying  to  him  from  his  having 

recently  appointed  a  chaplain.      lie   had   always   I n  free  from  .. 

•  in  wine,  tobacco,  women,  or  secret  lust  ;  but  he  read  very  hard   for  his 

•   in    fellowship,  and   took  a  good   deal  of  beer  at  dinner.     He  did  not 

acknowledge  to  any  indigestion  affecting  the  stomach:  but  on  inquiry  it  ap- 

1  that  he  had  latterly  had  that  peculiar  looseness  of  bowels  and  fetor  of 

which  j»i.  i.i  impelled  »'iuu> •:.  .ml  in  the  eveuiuguot 


292  NERVE    DISORDERS 

unfrequently  was  harassed  with  a  glugging  sound  in  the  bowels.  He  some- 
times perceived  black  specks  floating  before  his  eyes  previous  to  the  occur- 
rence of  the  faintness. 

I  gave  him  Quinine  and  Strychnine,  and  advised  his  playing  at  rackets,  in- 
stead of  taking  dull  constitutional  walks.  A  fortnight  afterwards  he  came  to 
report  himself  as  much  better. 

This  ortopia,  or  mental  helplessness,  would  seem  to  bear  a 
close  relation  to  the  vertigo  last  discussed.  It  is  one  of  the 
symptoms  falsely  represented  by  the  terrorist  advertisements  of 
quacks  as  due  to  former  habits  of  masturbation,  and  doubtless 
creates  on  this  score  a  good  deal  of  secret  alarm  among  the 
young  and  sensitive.  By  secret  alarm  it  is  much  aggravated. 
As  mentioned  in  CASE  XCIII,  it  is  sometimes  caused  by  snuffing, 
sometimes  by  mental  causes,  as  LXXVI  and  LXXYIII. 

As  mentioned  in  CASE  XIX,  it  will  sometimes  alternate  with 
diarrhoea  and  flatulence;  and  sometimes,  as  in  the  last  tale 
related,  the  intestinal  derangement  will  be  by  no  means  pro- 
minent, and  only  to  be  identified  by  cross-questioning. 

Another  form  of  cerebro-spinal  disorder  dependent  on  faulty 
digestion  is  EPILEPSY. 

CASE  CGXLV. — Late  one  night  in  June,  1854,  I  was  summoned  to  see  a 
patient  of  the  late  Mr.  Tegart,  Miss  W — ,  aged  13,  whom  I  found  in  a  violent 
epileptic  fit.  The  closeness  of  the  sleeping  nursery  showing  a  careless,  un- 
physiological  management,  I  suspected  corresponding  neglect  in  the  dietetic 
discipline  as  well.  I  accordingly  administered  a  stout  purge  and  the  next 
day  was  shown  a  chamber  utensil  full  of  hard  lumps  of  feces,  mixed  with  hulf- 
digested  fruit  and  other  rubbish.  The  patient  had  no  more  epileptic  fits. 

A  somewhat  similar  occurrence  to  this  quoted  in  page  70, 
where  the  indigestion  of  an  unaccustomed  amount  of  adipose 
aliment  induced  a  single  attack  of  epilepsy  not  repeated — at 
least  not  repeated  during  the  eight  months  which  elapsed  after 
I  wrote  that  narrative. 

As  acute  morbid  conditions  of  the  alimentary  canal  promote 
acute  epilepsy,  so  chronic  morbid  conditions  promote  chronic 
epilepsy,  that  is  to  say,  epilepsy  of  a  milder  but  more  confirmed 
character. 

CASE  CCXLYI. — In  November.  1863,  Dr.  Wallace  of  Parsonstown  sent 
to  consult  me  Mr.  James  E — .  It  appeared  that  he  had  become  subject  to 


CONNECTED    WITH    INDIGESTION.  293 

attacks  of  sometimes  partial,  sometimes  complete,  loss  of  sensibility,  preceded 
and  accompanied  by  a  cramp  in  the  arms  and  twitching  of  the  face.  Observa- 
tion of  the  stools  elicited  the  fact  that  they  frequently  contained  mucus.  A 
tonic  pill  of  Myrrh,  Aloe's,  Turpentine,  and  Henbane,  stayed  this  formation 
of  mucus.  Coincident  herewith  there  was  a  marked  improvement  in  the  ner- 
vous symptoms.  I  then  prescribed  Quinine  and  Strychnine,  but  have  no 
further  note  as  yet. 

In  the  next  case  of  improvement  by  management  of  the  diet 
tlu-re  is  recorded  the  symptom  which  I  take  to  intimate  the 
collection  of  mucus  in  the  stomach.1 

XI. VII. — Benjamin  M — ,  aged  about  40,  first  came  under  my 
charge  October  23d,  1858.  A  letter  he  brought  from  his  medical  man  des- 
cribed him  as  subject  to  confirmed  epilepsy  for  two  years.  Several  times  a 
week  he  got  giddy,  was  unable  to  stand,  sometimes  lost  his  senses,  sometimes 
was  convulsed,  but  rarely  bit  his  tongue.  After  the  paroxysms  he  always 
felt  tired,  and  usually  went  to  sleep.  He  had  always  been  temperate  in 
eatiiiLr,  drinking-,  sleeping,  and  matrimonial  matters,  and  could  assign  no  • 
for  his  epilepsy.  On  examination,  I  found  tenderness  on  pressure  at  the  pit 
of  tip-  stomach,  and  the  patient  said  that  he  felt  as  if  a  weight  were  laid  on 
that  part,  especially  during  wet  and  cold  weather. 

To  restrain  the  secretion  of  mucus,  I  ordered  him  a  quarter  of  a  grain  of 
Nitrate  of  Silver  night  and  morning,  and  some  Bismuth  and  Sesquioxide  of 
Iron  twice  a  day.  l>ut  the  most  important  part  of  the  prescription  was  as 
follows  :  ••  Avoid  beer,  pastry,  fruit,  sugar,  tea,  and  coffee.  In  place  of  the 
latter,  take  milk  and  soda-water,  with  stale  bread  or  biscuit,  for  breakfast. 
At  dinner  eat  once-cooked  plain  meat,  stale  bread  and  green  vegetables." 

,11  November  18th,  1858;  no  improvement  had  resulted,  and 
all  I  could  do  was  to  encourage  him  to  persevere. 

I  did  not  receive  another  visit  till  July  5th.  ISIiO.  when  he  reported  that  he 
hardly  ever  had  any  attacks  of  giddiness;  indeed,  never  except  after  violent 
To  my  surprise,  and  at  first  consternation,  he  said  he  had  been 
continuing  the  Nitrate  of  Silver,  with  occasional  intermissions  of  a  week  or 
so.  up  to  that  time.  No  discoloration  of  the  skin  had  occurred,  however.  I 
then  gave  him  some  Citrate  of  Quinine  and  Iron,  which  a  letter  from  his  wife 
reports  set  him  in  strong  health  in  a  few  weeks. 

II.-  had  no  more  tits  till  IMI-J.  when  over-attention  to  business  seems  to  have 
deranged  his  digestion,  and  he  had  a  few  slight  epileptic  attacks  while  dn 
in  the  morning.     1  advi.-ed  a  recurrence  to  his  former  dietary  and  to  the  lu.-t- 
prescribed  medicine. 

In  the  spring  of  \-M  he  called  to  report  that  he  had  pot  quite  well,  and 
kept  so  up  to  that  date  by  dint  of  adhering  to  a  strict  plan  of  diet,  grounded 
on  the  one  I  had  written  out  in  1- 

p.'ige  171. 


294  XERVE    DISORDERS 

The  omission  of  a  single  article  from  the  diet- table  will  suffice 
sometimes. 

CASE  CCXLYIII. — Rev^  George  0 — ,  aged  about  24,  married,  was  first 
my  patient  in  August,  1856,  for  non-syphilitic  periosteal  rheumatism  which 
completely  crippled  him.  but  vanished  with  remarkable  rapidity  under  the 
use  of  Iodide  of  Potassium.  He  continued  well  till  September,  1861,  when 
he  began  to  have  epileptic  fits.  He  came  to  me  in  May,  1862,  when  I  kept 
him  a  month  in  London,  and  seeing  the  former  success  of  Iodide  of  Potassium 
in  one  disease  in  his  case,  tried  it  again  in  another.  While  in  London  he  was 
free  from  fits,  but  no  sooner  did  he  return  home  than  they  became  worse  than 
ever,  though  he  increased  the  dose  of  the  Iodide.  So  he  left  it  off,  and  when 
I  next  heard  he  was  taking,  under  advice,  mercurial  alteratives  "  to  act  on  the 
liver"  and  so  on,  not  apparently  with  any  advantage. 

I  next  saw  him  in  January,  1867,  when  he  said  the  fits  had  become  so  fre- 
quent and  occurred  at  such  inconvenient  times,  that  he  had  been  forced  to 
give  up  his  clerical  work.  I  had  originally  advised  that,  and  indeed  it  was 
in  consequence  of  that  advice  that  he  had  deserted  me.  However,  that  idle- 
ness did  no  good,  till  some  person  recommended  him  to  give  up  beer,  and  from 
that  date  the  epilepsy  began  to  improve.  The  said  drink  had  always  made 
him  flatulent,  and  he  had  found  his  digestion  much  better  since  he  took  only 
water.  He  was  anxious  to  try  some  Bromide  of  Potassium,  and  I  allowed 
him  to  do  so,  but  still  urged  him  to  persist  in  his  abstinence,  as  to  that  I 
attributed  his  improvement. 

In  March  he  called  to  report  that  he  had  had  only  one  fit,  and  in  that  con- 
sciousness was  not  entirely  lost. 

Iodide  and  Bromide  of  Potassium  seem  to  have  a  peculiar 
restorative  action  over  the  white  fibrous  tissues.  They  were 
first  brought  under  the  notice  of  the  profession  by  the  effect  of 
Iodine  in  scrofulous  diseases  of  the  glands,  and  then  by  their 
cure  of  syphilitic  periostitis.  A  notion  got  into  the  profession 
that  they  had  some  antagonistic,  or  controlling,  or  evacuating 
power  over  syphilitic  virus;  but  the  more  recent  surgical  writers, 
such  as  Mr.  Lee,  think  there  is  evidence  against  that  idea,  and 
that  they  benefit  by  curing  the  diseases  arising  out  of  the  pre- 
sence of  the  virus,  and  not  by  removing  the  virus  itself.  They 
cure  the  patient's  tissues  without  specially  affecting  the  materies 
morbi,  equally  in  rheumatic  as  in  venereal  cases  of  periosteal 
disease,  ^yhen  recently  affected,  these  patients  are  restored  to 
health  as  readily  as  the  subjects  of  secondary  syphilis;  and  the 
apparent  resistance  in  some  cases  to  the  remedy  is  due  to  the 
protracted  nature  of  the  ailments ;  just  as  syphilitic  periostitis, 
when  it  has  lasted  a  long  time  without  medical  aid,  is  very 


CONNECTED    WITH     I  \  1>I  GESTION'.  295 

Mate  also.     On  the  ground  that  Iodide  of  Potassium  has  a 

.il  restorative  power  over  the  white  fibrous  tissues,  I  should 

•  liivct  benefit  from  it  in  epilepsy  to  those  cases 

where  epilepsv  is  «lue  to  some  le.-ion  of  the  membranes  of  the 
•ral  or  other  masses  <>t'  nerve  substance,  whether  that  lesion 
nporarv  or  permanent  :  ami  I  am  not  surprised  at  its  failure 

in  the  gastric  cases  we  are  now  discussing. 

In  the  i  •  the  flatulent  distension  of  the  bowels  before 

the  :'••  the  epilepsy  with  deranged  digestion. 

Perhaps  the  disease  is  too  ]..;  tined  for  cure;  perhaps  I 

did  not  p;iv  sufficient  attention  to  dietetics  at  that  date;  but,  at 
all  events,  favorable  results  have  not  followed  the  use  of  drugs. 

\  1  .1  X  .  A  .  <  ;  —  ,  aged  about  40,  first  came  to  me  iu  January,  1851, 
after  having  been  a  patient  <>t'  the  late  Dr.  \V.  F.  Chambers  for  five  years  for 
epileptic  attacks,  occurring  about  every  fortnight  or  three  weeks.  He  had 
Keen  taking  Sulphate  of  /ine  (gr.  iij  bis  die)  and  much  purgative  medicine, 
and  I  continued  the  prescription. 

w  him  from  time  to  time  during  the  next  two  years,  and  found  that  the 
fits  wen-  invariably  preceded  by  flatulence  and  distension  of  the  bowels,  but 
immediately  announced  by  perspirations  and  pale  urine.  By  the  end  of  1852 
the  fits  hud  In-come  li-ss  violent,  and  assume'!  a  regular  periodicity,  coming  on 
••very  eighth  night  between  ten  minute-  before  and  ten  minutes  after  twelve- 
I  do  not  think  he  made  any  more  attempts  to  get  well. 

I  am  afraid  one  cannot  in  such  cases  find  much  fault  with  a 

despairing  patient:  so  few  are  the  instances  in  which  an  epi- 

whieh  has  assumed  a  regular  periodicity,  at  the  same  time 

that  it  grows  milder,  ever  is  cured.     It  is  possible  there  may 

i  structural  brain  disease,  and  that  the  indigestion  was 

only  the  motive  cause  of  the  eilepsy. 

There  is  a  sort  of  modified  chronic  chorea  which  seems  de- 

pendent on  chronic  causes  in  the  alimentary  canal,  just  as  acute 

ID   dependent   on  acute  rauses.     I   call  worms  (for 

example)  acute,  '  movable  and   temporary,  and 

directly  they  are  gone  the  derangements,  tend    to  get  well  of 
their  own  accord.1 


••  the  distinctions   drawn   '  Mmnir"  in   th-  Intro- 

duction. i'.-iir«-  '--  an.i   note.     S-f   ;il.-"  hielly  Clinical," 

'ire  xxx. 


296  NERVE    DISORDEES 

CASE  CCL. — C.  J — ,  aged  26,  an  accountant,  came  to  me  on  February  5. 
1867,  in  much  shame-faced  fear,  tinder  the  idea  that  his  state  of  health  was 
the  delayed  retribution  for  nasty  habits  of  se'cret  lust  practised  when  he  was 
a  boy.  He  was  troubled  with  involuntary  twitches  of  the  facial  muscles,  low 
spirits  and  causeless  fears.  His  breath  felt  hot  to  him ;  his  scalp  and  anus 
itched ;  and  the  abdomen  seemed  to  burn  as  he  lay  in  bed.  His  sleep  was 
disturbed  by  terrible  dreams.  The  spasmodic  movements  of  the  face  were. 
however,  what  troubled  him  most  as  a  man  of  business,  for  they  made  him 
ridiculous,  and  the  more  he  endeavored  to  control  them,  the  worse  they  were. 

The  urine  was  natural.  Indeed,  I  could  detect  nothing  contrary  to  nature 
in  the  functions  of  the  body,  except  in  those  of  the  alimentary  canal,  whose 
excretions  were  reported  very  fetid  at  times. 

He  had  taken  Zinc  and  other  specifics  without  advantage. 

I  gave  him  Valerian  for  two  days  with  some  improvement  of  the  sleep  (but 
it  is  possible  that  improvement  may  have  been  due  to  his  mind  being  set  at 
rest  respecting  his  youthful  nastiness)  and  then  put  him  on  Quinine  and  Oil 
of  Rosemary,  which  he  continues  to  take  with  some  benefit. 

Symptoms  like  these  are,  again,  engines  bj  which  the  adver- 
tising quacks  extort  money.  It  is  difficult  to  avoid  having 
their  obscene  literature  thrust  into  one's  hands,  and  it  often 
leaves  torturing  scars  on  the  mind  for  life. 

Minor  degree  of  reflex  manifestations  of  nervous  action 
assume  more  familiar  forms.  Thus  we  have  very  commonly 
what  is  known  as  "  STOMACH  COUGH,"  that  is  to  say,  cough 
without  any  bronchial  secretion  or  other  morbid  condition  of 
the  lungs,  and  connected  with,  aggravated  by,  and  yielding 
simultaneously  with,  catarrhal  relaxation  of  the  mucous  coats 
of  the  stomach.  Usually  we  may  infer  this  gastric  derange- 
ment from  the  symptoms ;  sometimes  we  have  the  confirmation 
(afforded  in  the  case  I  will  quote  as  an  illustration)  of  a  similar 
catarrhal  condition  appearing  at  the  visible  extremity  of  the 
alimentary  canal. 

CASE  CCLT. — Henry  L — ,  a  manufacturer,  aged  about  30  when  he  first 
consulted  me  in  January,  1861,  complained  of  a  constant  hacking  cough,  with- 
out expectoration  generally,  but  still  aggravated  by  damp  chilly  weather,  and 
of  pain  in  the  left  mammary  region.  His  face  was  pale  and  flabby,  and  he 
had  a  tendency  to  grow  fat.  The  chest  was  quite  healthy  as  far  as  could  be 
ascertained  by  the  ear.  He  got  better  under  the  use  of  Quinine,  and  after  a 
few  visits  I  did  not  see  him  again  till  November,  1863,  when  he  came  to  me 
with  a  recurrence  of  his  former  symptoms.  He  in  addition  complained  that 
"his  chest"  (pointing  to  his  epigastrium)  "gets  stuffy  and  feels  too  large." 
The  uvula  was  much  relaxed,  and  on  looking  into  the  throat,  it  seemed  to  be 


CONNECTED    WITH    INDIGESTION*.  .          297 

redder  as  you  go  down  deeper.     Acting  on  this  hint  I  have  since  accompa- 
nied tin-  tonics  by  gargles  of  Oak-bark  and  Alum,  and  subsequent  a; 

jot  better  the  quicker  for  them.     On  leaving  England,  in  December. 

I  commended  him  to  another  doctor;  but  he  came  to  me  in  October, 

-nying  that  he  had  been  quite  well  till  then,  when  exposure  in  the  coun- 

try during  the  wet  autumn  had  brought  on  an  unusually  bad  attack.     I  never 

saw  his  throat  so  red,  and  he  said  he  could  feel  his  oesophagus  all  the  way 

down  to  the  pit  of  the  stomach.     A  course  of  Quinine  restored  him  to  his 

usual  health.     Hut  a<:ain  in  April  he  has  come  again  with  a  sore  throat  and 

ness,  and  this  time,  as  in  1861,  he  has  got  a  hacking  cough,  and  is  con- 

vinced. as  is  also  his  wife,  that  he  is  going  into  a  consumption.    The  chest 

is  quite  normal  on  examination,  but  the  uvula  is  much  lengthened  and  the 

throat  red.     There  is  great  weight  at  the  epigastrium  after  food,  and  a  sensa- 

tion in  the  oesophagus  leading  him  to  hawk  mucus  continually. 

Apropos  of  the  relaxation  of  the  uvula,  I  may  mention  that  he  made  it 
much  worse  at  the  first  by  violently  causticing  the  back  of  the  fauces  with 
Nitrate  of  Silver. 

These  cases  are  best  treated  by  astringents,  but  changes  of 
:ier  must  be  guarded  against  with  especial  care.     Without 
the  aid  of  the  stethoscope  they  might  readily  be  mistaken  for 
pulmonary  consumption. 

The  following  is  a  very  fair  typical  example  of  symptoms 
such  as  these  occurring,  as  they  often  do,  in  a  gouty  constitu- 
tion. 

CARE  CCLII.  —  S  —  ,  a  burly  country  gentleman  of  50,  used  to  have  regular 
attacks  of  acute  gout  in  the  small  joints  three  times  a  year  till  1863,  when 
they  ceased,  liut  their  place  is  taken  by  a  worse  enemy.  For  as  October 
mines  round  annually  his  throat  gets  sore  and  livid  red,  or  else  he  has  a  fre- 
quent liackinir  cou^h.  and  sometimes  both  evils  together.  There  is  a  1'i-uliug 
of  weight  at  the  epigastrium  after  food,  and  a  discomfort  scarcely  to  be  called 
pain,  on  pressure  of  the  lower  part  of  the  stomach.  The  bowels  are  apt  to 
be  loose,  but  lie  usually  restrains  the  looseness  from  proceeding  to  diarrhoea 
by  Opium.  (Dt<:  I'.''/,.  1*66.) 

Iti  tin*  last  case  the  pains  of  gout  alternated  with  the  stomach 
cough  and  sore  throat,  but  in  some  unfortunates  they  may  both 
occur 


(  '  \-'  :  i  (  'I.I  1  1.      C.  '  .  !   11.  H  tlie  1  1  rot  her  of  n   patient  who  ha<  Keen 

under  my  care  for  gout,  and  ha*  him>elf  lieeii  bald  from  an  early  air-1.  He 
reports  also  that  f.  inner  L'eneratinn<  of  the  family  have  been  uouty.  He  h.i- 
been  under  my  can-  sinre  Novemli,  :  •  intermittent  sciatica  and 

•tiff-neck,  much  dependent  uti  the  condition  of  the  .-tomac  h.  and  which  1  con- 


298  NERVE    DISORDERS 

sider  therefore  to  have  a  gouty  character.  He  was  desirous  of  reporting  im- 
provement in  this  as  time  went  on,  but  I  cannot  say  I  thought  it  any  better 
in  January,  1867,  when  he  began  to  have  cough  and  then  a  red  swollen  throat. 
The  lower  lobes  of  the  lungs  are  apt  also  to  become  congested  occasionally  ; 
but  he  never  expectorates  with  his  cough,  which  seems  to  vary  much  with 
the  weather  and  state  of  the  stomach.  I  treated  him  for  some  time  with 
Quinine,  Iodide  of  Potassium,  Baths,  £c.,  without  any  advantage.  In  Feb- 
ruary I  gave  some  unpalatable,  or  impracticable,  advice  as  to  change  of 
climate  and  lost  sight  of  him. 

Another  form  of  the  influence  of  gastric  derangement  upon 
the  nervous  system  is  the  production  of  morbid  ANAESTHESIA. 
As  I  remarked  respecting  headache  the  most  frequent  instances 
are  found  amongst  those  who  have  already  made  the  nervous 
system  susceptible  of  disease  by  overstraining  it. 

CASE  CCLIV. — An  American  speculator,  aged  48,  was  sent  to  me  in  June, 
1866,  by  Dr.  Forsyth  Meigs,  of  Philadelphia.  He  had  lost  a  fortune  of  ten 
thousand  a  year  by  the  civil  war,  so  that  he  had  to  begin  life  orer  again — an 
ordeal  not  so  severe  in  the  United  States  as  in  England,  but  still  an  ordeal 
anywhere ;  he  had  worked  energetically  to  recover  his  position  ;  he  had  thrown 
himself  into  the  turbulent,  rather  than  the  quiet  joys  of  life  ;  and  he  had  also 
gone  through  certain  matrimonial  difficulties  not  unscathed.  In  August, 
1864,  he  was  taken  with  vomiting  and  loss  of  appetite,  general  debility,  defi- 
cient sleep,  and  occasional  flatulence.  These  ordinary  digestive  derangements 
were  the  only  trouble  till  the  end  of  September  in  the  same  year,  when  he 
found  gradually  creeping  over  his  hands  and  feet  a  peculiar  sensation  of  numb- 
ness ;  not  what  is  commonly  called  "pins  and  needles,"  but  a  bluntness  of 
perception  especially  in  the  finger-tips,  so  that  he  did  not  know  when  he  was 
touching  a  small  object,  unless  he  saw  it ;  and  he  often  tripped  from  not  de- 
tecting a  small  impediment  in  walking.  On  resuming  matrimonial  privileges, 
after  an  interval  of  abstinence  on  account  of  his  health,  he  found  that  emission 
occurred  immediately  on  entrance,  or  even  before  entrance  was  effected.  His 
head  had  been  bald  since  the  age  of  twenty,  but  in  general  respects  he  is  a 
young-looking  man.  The  specific  gravity  of  the  urine  before  breakfast  is 
1.025,  after  breakfast  1.015.  Under  the  use  of  nutritious  diet,  abstinence 
from  alcohol,  and  from  over-much  anxiety  in  business,  and  of  Nux  Vomica 
and  Quinia,  prescribed  by  Dr.  Meigs,  his  digestion  had  strengthened  and  the 
sensation  was  returning  by  degrees  to  his  extremities.  I  thought  he  could 
not  do  better  than  take  a  course  of  the  same  drugs  for  ten  days  in  each 
month,  and  follow  strictly  the  plan  of  life  laid  down  for  him  by  his  first-rate 
physician.  It  is  proposed  that  he  shall  spend  a  few  years  in  taking  his 
daughter  round  the  chief  cities  of  Europe. 

He  called  on  me  early  this  spring  of  1867  to  report  improvement. 

Cases  such  as  this  last  receive  all  sorts  of  names,  according 
to  the  prevailing  theories  of  the  period ;  which  nomenclature 


CONNECTED    WITH    INDIGESTION.  299 

does  the  patient  no  harm  so  long  as  the  theory  does  not  influ- 

the  treatment.     The  principal  danger  is  lest  he  may  fall 

into  the  hands  of  a  counter-irritator,  who  should  depress  the 

vital  powers  l»v  making  sore  places  over  the  spots  where  he 

supposes  chronic   inflammation  to  exist.     Electricity  probably 

no  harm,  but  it  will  be  observed  that  recovery  is  always 

coincident  witli  an  improvement  in  the  digestion,  and  I  think 

attention  to  this  function  is  our  leading  duty;  and  alone  it  may 

be  followed  by  a  cure,  so  that  there  is  no  need  of  additional 

bment 

The  loss  of  nervous  function  in  some  cases  is  manifested  in 
the  nerves  of  motion  principally,  or  even  solely.  We  must 
;me  that  it  depends  on  the  specialities  of  the  nervous 
system  itself  in  each  individual  which  portion  of  it  be  affected, 
and  that  the  influence  of  the  alimentary  canal  is  general ; 
otherwise  we  should  be  able  to  map  out  certain  tracts  as  ruled 
over  by  certain  viscera,  and  not  find  motor  and  sensory  fibres 
indifferently  injured  by  imperfection  of  the  stomach. 

I/V. — Colonel  IJ — ,  aged  43,  applied  for  my  opinion  on  the  30th  of 
July.  IH'I(».  about  a  loss  of  power  in  the  legs.  He  has  always  had  a  "weak 
stomach."  feeling  a  weight  at  the  epigastrium  if  he  takes  liberties  with  his 
diet,  or  is  exposed  to  a  damp  cold.  In  the  summer  of  1H>.">  his  siom.irli 
difficulties  were  particularly  bad.  and  then  he  began  to  notice  what  he  called 
a  "  iidiretine»<"  nf  the  !••;:-.  inducing  him  to  kick  and  stretch  them  about. 
Then  he  found  1  -  and  |*M  able  to  walk,  and  then  there  was  pain  in 

the  leirs  felt,  imperially  after  any  exertion.  A  mile  was  the  utmost  he  was 
able  to  walk  when  I  saw  him.  He  had  been  galvani/.cd  and  had  tried  a  variety 
of  medical  treatments,  without  any  advantage  that  he  could  discover;  the 
only  improvement  lie  could  ever  notice,  was  when  he  was  in  the  bracing  air 
of  Scotland.  On  this  hint  1  sent  him  thither,  with  a  prescription  for  Quinine 
and  Strychnine.  I  heard  from  him  in  August  that  he  digested  better  and 
walked  better,  but  that  the  pains  were  bad  in  the  legs  at  night  I  added 
therefore  to  his  mixture  four  grains  per  dose  of  Iodide  of  1'ota-siuin. 

In  this  instance  the  >eus.>ry  tracts  do  not  seem  to  be  injured 

at  all.      And  the  paralysis   is   not  sufficiently  complete  to  cause 

atrophy  from  deficient  use  of  the  muscles.     Indeed,  in   gastric 

-iif  I  may  so  cali  it  I  1  have  never  seen  the  loss  of  power 

:;s  to  deprive  the  mu.-eles  <>f  that  amount  of  motion 

which  is  conducive  to  /ients  can  alway- 


300  NERVE    DISORDERS 

about  a  little,  are  willing  to  do  so,  and  very  often  disposed  to 
exert  themselves  too  much. 

This  is  an  important  point  in  the  treatment ;  for  if  what  I 
have  remarked  is  true  universally,  we  shall  be  doing  harm  by 
following  the  common  practice  in  telling  the  patients  to  employ 
and  exercise  the  muscles  as  much  as  possible ;  we  ought  rather 
to  impress  upon  them  the  necessity  of  avoiding  such  an  amount 
of  motion  as  nature  warns  us  against  by  the  sensation  of  conse- 
quent fatigue. 

When  atrophy  of  the  muscles  has  any  connection  with  de- 
rangement of  the  digestive  organs,  it  is  usually  to  be  traced  to 
overwork  rather  than  to  underwork.  Of  this  I  will  quote  an 
instance  which  I  have  previously  made  use  of  in  the  later 
editions  of  my  Clinical  Lectures. 

CASE  CCLVL— (Clinical,  St.  Mary's,  June  I3th,  1863.)  Nathaniel  B—  is 
a  top-sawyer  by  trade,  aged  45,  and  was  always  a  hearty  fellow,  able  to  do  a 
good  day's  work,  till  ten  months  ago ;  when,  after  violent  exertion  in  turning 
over  a  mass  of  timber,  he  got  what  he  calls  "  a  wrench"  in  the  pit  of  the 
stomach,  and  ''  has  never  been  the  same  man  since."  The  appetite  failed,  and 
therewith  the  strength  ;  the  muscles  wasted,  and  the  whole  body  grew  emaci- 
ated. The  loss  of  appetite  then  became  entire,  and  then  increased  to  an 
utter  loathing  of  food.  He  went  into  Guy's  Hospital  three  months  ago,  but 
left  apparently  dissatisfied  and  ungrateful.  On  gaining  admission  to  St. 
Mary's,  May  22d,  he  seemed  much  cast  down,  expecting  never  to  get  any 
better.  He  was  able  to  walk  about,  and  the  chief  loss  of  power  seemed  in 
the  shoulder-muscles,  the  deltoid  and  biceps  ;  and  when  he  tried  to  "  put  up" 
the  latter,  that  is  to  throw  into  it  the  contractile  nervous  force,  it  felt  quite 
soft,  without  any  of  the  corky  elasticity  which  distinguishes  a  sawyer's  arm. 
He  is  the  father  of  thirteen  children,  but  since  the  commencement  of  his 
present  illness  he  has  entirely  lost  virile  power.  He  states  himself  to  be  a 
perfectly  sober  moderate  man,  and  has  a  good  character  on  that  score  from 
his  employer. 

It  is  scarcely  necessary  to  say  that  the  epigastrium  and  hepatic  region 
were  carefully  examined  for  evidence  of  cancerous  degeneration,  and  none 
was  found.  The  lungs  also  were  thoroughly  auscultated,  and  nothing  abnor- 
mal was  detected,  beyond  a  suspicion  of  slight  comparative  dulness  in  the 
right  apex.  He  had  not  suffered  from  habitual  cough  or  had  any  diarrhoea. 

He  was  at  first  kept  in  bed  and  given  milk  and  beef-tea  every  two  hours, 
with  ten  grains  of  Boudault's  Pepsine  powders  three  times  daily.  In  a  few 
days  his  excessive  nausea  and  lowness  of  spirits  had  abated,  and  he  was 
ordered  six  grains  of  Quinine  and  three  drachms  of  Cod-liver  Oil  daily  in 
addition.  In  a  few  days  more  he  was  tried  with  half  a  mutton-chop,  digested 


CONNECTED    WITH    INDIGESTION".  301 

it  well,  and  on  the  6th  of  June  was  able  to  take  oar  whole  ordinary  diet  a 
])int  of  milk.  and  a  pint  <>f  beet-tea,  and  a  pint  of  porter.     On  the  l-il, 
terday;  In-  was  so  much  better  that  I  thought  it  was  scarcely  justifiable  to  let 
him  o.-ciipy  a  place  in  the  hospital  any  longer,  and  I  trust  he  will  be  able  to 
:i  as  an  out-patient. 

he  was  confined  to  bod  at  first,  it  was  not  convenient  for  some  days  to 
put  him  in  the  scales ;  but  on  May  tlu>  24th  we  found  his  weight  8  st. 
pounds  :  on  the  30th,  8  stone  7£  pounds ;  on  June  6th,  8  stone  10  pounds;  on 
•June  llith,  8  stone  10$  pounds;  his  height  being  5  feet  6. inches. 

Tlu-  only  day  on  which  he  did  not  take  Pepsine  was  May  29th,  when  our 
stock  was  accidentally  exhausted,  lie  then  complained  of  pain  at  the  epi- 
irastrhim,  and  attributed  that  to  the  omission  of  his  powders. 

A  -omewhat  similar  case  is  related  page  37  (CASE  VIII). 

Now,  had  this  sawyer  been  a  gentleman  in  easy  circum- 
stances, the  excessive  waste  would  not  have  been  habitual,  and 
lie  would  not  have  had  muscular  atrophy  of  the  limbs.  The 
'•wrench"  would  have  been  confined  to  the  stomach,  and  he 
would  probably  have  suffered  only  from  imperfect  indigestion, 
like  the  sporting-man  (CASE  XIII)  whose  partial  paralysis  of 
the  stomach  dated  from  hallooing  and  running* on  Derby-day. 
As  he  went  on  in  life,  any  extra  exertion  would  have  induced 
flatulence,  as  in  the  old  fox-hunter  (CASE'XII).  Or  if  he  had 
been  in  vigorous  bloom,  the  paralysis  would  have  been  only 
temporary,  as  in  CASES  IX,  X,  XL  The  proneness  to  muscular 
atrophy  may  have  long  existed;  but  no  harm  happened  so  long 
as  the  stomach  was  able  to  go  on  supplying  nutriment  en< 
to  compensate  the  extreme  waste  of  the  violent  exertions.  No 
sooner  does  its  debilitated  condition  fall  below  a  certain  point 
than  atrophy  is  exhibited  suddenly  and  proceeds  at  a  frightful 

The  only  cases  in  which  the  easy  classes  are  likely  to  be 
similarly  affected  is  when  injudicious  friends  urge  them  to  exer- 
tions for  the  good  of  their  health,  or  where  brain-work  occupies 
the  hostile  post  held  by  body-work,  as  in  the  instance  befor- 

•«ther  symptom  of  gastric  weakness  which  obscene  adver- 

•  wont   to  turn  to  their  profit,  as  well  a-  ami 

chorea,  is  Fi.rsiiiM;  OF  THK  FACK,  or  Causeless  blushing.     Tins 

would   be  sufficient    to   show   that    it  common    in 

healthy  persons;  but  rarely  does  it  grow  bad  enough  to  consult 

a  physician  about. 


302  XEftVE    DISORDERS 

CASE  CCLVII. — Mrs.  R — ,  aged  56.  put  herself  under  my  charge  in  June, 
1866,  stating  that  for  the  last  half-dozen  years — in  fact,  since  the  cessation  of 
the  catamenia — she  had  suffered  from  flushings  of  the  face  at  irregular  times, 
accompanied  by  palpitations  of  the  heart,  so  severe  that  she  thought  that 
organ  must  be  organically  diseased.  On  examination,  I  found  it  healthy  in 
all  respects. 

On  inquiry,  I  elicited  that  she  suffered  excessively  from  intestinal  flatulence, 
especially  of  an  evening,  and  not  uncommonly  had  heartburn  at  night,  if  she 
ate  pastry  or  took  sugar  in  her  tea. 

When  she  came  to  me  she  had  been  latterly  much  worse  than  usual,  and 
this  I  traced  to  annoyance  about  a  love  difficulty  of  her  favorite  son. 

A  month's  course  of  Quinine  and  Strychnine  twice  a  day  dissipated  gradually 
the  inconvenience  she  suffered ;  but  she  remained,  and  probably  considering 
her  age  always  will  remain,  a  very  nervous  subject. 

A  higher  degree  of  the  same  phenomenon  constitutes  NETTLE- 
RASH,  which  is  always  partially  traceable  to  the  stomach,  as 
is  shown  by  the  relief  afforded  by  a  change  of  diet,  a  change 
sometimes  seemingly  insignificant. 

CASE  CCLVIII. — Miss  C.  R — ,  aged  35  or  so,  was  a  patient  of  mine  in  the 
summer  of  1866  for  nettlerash,  which  for  the  last  six  years  had  made  her 
mornings  miserable  to  her,  coming  on  in  her  legs  directly  they  are  put  out  ot 
her  warm  bed.  She  had  tried  all  sorts  of  treatment  in  vain;  nothing  seemed 
to  do  her  any  good.  The  chief  things  which  make  her  worse  are  being  worried, 
and  getting  wet  through  when  riding. 

I  have  given  her  Soda,  Liquor  Ammoniae,  &c.,  without  any  apparent  effect; 
but  what  really  seems  to  afford  the  greatest  relief  is  leaving  off  all  alcoholic 
liquids,  tea,  and  fruit. 

CASE  CCLIX. — R.  V.  E — ,  aged  50,  a  commercial  man,  requested  my 
advice  in  February,  1850,  about  a  peculiar  kching  papular  eruption.  Observ- 
ing that  it  ran  in  straight  lines,  and  was  only  in  the  front  parts  of  the  body 
commanded  by  the  hands,  I  questioned  him  further,  and  found  that  it  only 
appeared  when  scratched,  and  in  the  morning  assumed  the  form  of  "  wheals." 
He  confessed  that  eating  pickles  and  drinking  hard  beer  used  to  bring  on 
these  "  wheals,"  but  that  he  had  for  some  time  carefully  avoided  all  acids. 
The  only  unnecessary  that  I  could  detect  among  his  '•  non-naturals"  was  the 
use  of  tobacco.  lie  allowed  that  strong  shag,  in  which  he  indulged,  certainly 
did  somewhat  upset  his  stomach  and  make  his  hand  shake. 

Leaving  off  smoking  at  night,  and  using  only  light  cheroots  by  day,  cured 
him,  with  the  help  of  a  little  Liquor  Ammonise.  His  nettlerash  got  well, 
when  his  nerves  and  his  stomach  returned  to  their  duty  together. 

That  nettlerash  is  a  phenomenon  connected  with  imperfect 
innervation  I  have  the  evidence  of  the  following  personal  expe- 
rience. A  few  years  ago  I  was  unfortunate  enough  to  have  a 


CONNECTED    WITH    I  .VDIOESTIO.V.  303 

•eal  aneurism.  When  this  came  to  press  habitually  upon 
the  nerves  of  the  ham,  of  which  my  sensations  gave  me  due 
notice,  1  remarked  that  bathing  in  cold  water  brought  on  nettle- 
rash,  invariably  confined  to  the  alVeeted  leg  only,  and  never 
since  su tiered  from. 

v,  when  an  individual  has  a  nervous  system  less  powerful 
than  the  rest  of  the  body,  let  them  be  females,  feminine  men, 
or  men  with  habits  debilitating  to  innervation,  any  gastric 
derangement  is  liable  to  bring  on  nettlerash  among  other 
svmptoms,  just  as  the  cold  water  brought  on  nettlerash  in  the  leg 
whose  innervation  was  partially  cut  off.  That  is  my  theory,  and 
that  is  why  I  introduce  nettlerash  in  this  somewhat  unusual 
;.ection. 

In  the  next  case  the  eruption  on  the  skin,  though  clearly 
dependent  on  the  digestive  organs,  was  not  of  such  a  char, 
as  to  be  correctly  called  Nettlerash ;  it  was  rather  an  "Erythema 
circumscrijitum."  (I  presume  in  cutaneous  pathology  one  may 
be  allowed  to  invent  a  nomenclature  that  best  suits  the  case  in 
hand,  inasmuch  as  no  one  treats  the  patient  in  obedience  to  the 
nomenclature.)  The  depression  of  spirits  and  causeless  fears 
point  out  that  connection  of  the  pathology  of  the  case  with  the 
nervous  system,  which  I  have  alluded  to  above. 

1  '  '  I.X.  \V.  L — ,  a  country  gentleman  of  52,  of  robust  jovial  aspect, 
square  set  and  muscular,  comes  of  a  pouty  family;  but  he  has  never  developed 
in  hi>  own  person  his  damnosa  hcf"l-i<i-  in  its  typical  form,  having 
felt  any  swelling  "r  pain  in  any  of  the  joints-or  tendons.  He  placed  himself 
under  my  care  on  the  15th  of  May.  1867,  on  account  of  attacks  of  which  the 
;iiLr  i>  the  u.-ual  eour.-e.  About  every  three  or  four  weeks  he  finds  a 
dreadful  depression  of  spirits  comes  over  him,  without  any  cause  or  previous 
excitement  ;  the  urine  become-  •  ly  copious  and  pale  colored,  and  is 

•  I  with  preat  frequency.  Then  commences  pastric  flatulence,  i 
burst  in;:  up  from  the  stomach  in  luicli  i|iiantities  as  to  wake  him  up  at  niirht  ; 
mid  at  the  >ame  period  the  heart  thumps  airain-l  the  ril>s  \\ith  extraordinary 
and  frequency.  The  appetite  is  quite  lost,  and  disgust  to  food  takc>  its 
place.  I'.ut  there  is  con>iderable  thir>t.  and  the  toiipue  is  furred,  clammv, 
iiml  dry.  The  urine  now  :rets  scanty,  and  a-  h it'll  colored  sometimes  as  porter, 
but  never  thick.  Then  lie  begins  to  brinp  up  clear  fluid  from  the  mouth 
nearly  every  hour  in  pushes  of ' -everal  "itncc,  at  a  time.  The  fluid  is  alwavs 
sour,  and  after  meals  i>  intensely  80  to  tin-  t:i«t.-.  Th«-.-e  attacks  have  ordi- 
narily ceased  in  about  four  days,  and  ih--  •  from  them  is  almost 
always  announced  l.y  a  peculiar  eruption  on  li.  •••dally  <>u  thai  of  the 


304  XERVE    DISORDERS. 

belly  and  legs.  Sometimes  they  last  longer,  and  notably  on  the  occasion  of 
his  first  coming  to  my  house  he  had  been  ill  off  and  on  for  three  weeks,  occa- 
sionally having  a  remission  but  never  quite  free.  When  1  saw  him  the  tongue 
was  much  furred,  he  had  no  appetite,  and  had  been  throwing  up  the  acid  fluid 
already  that  morning.  In  spite  of  a  round  red  face  he  really  had  the  aspect 
of  great  mental  distress,  quite  incommensurate  with  the  degree  of  pain  expe- 
rienced. In  spite  of  the  depression  of  spirits  his  mind  was  quite  clear,  and 
capable  of  business  (if  he  had  any),  and  there  was  no  vertigo  or  headache. 
During  the  three  weeks  he  had  lost  fifteen  pounds  in  weight.  The  epigas- 
trium was  very  drummy  on  percussion,  the  resonance  stretching  to  an  abnor- 
mal extent  from  side  to  side,  so  as  to  show  a  very  large  stomach.  The  belly 
however  was  flat,  though  he  is  a  broad  dumpy  man.  I  prescribed  (May  17th, 
1867)— 

R. — Quinise  Sulphatis,  gr.  ij, 

Strychnia?  Hydrochloratis,  gr.  2\y, 

Succi  Limonum  quant,  suff.,  ad  ilia  sol  venda, 

Aquae  ad  fl,5j, 

Potassii  lodidi,  gr.  iij  ;  bis  die. 
R. — Pilulae  Aloes  cum  Myrrha,  gr.  iv, 

Strychnia?  Hydrochloratis,  ^  ;  omni  nocte  ; 

and  desired  him  to  call  again  in  four  days.  He  was  advised  to  take  no  stimu- 
lants at  all. 

On  the  second  visit  I  had  an  opportunity  of  seeing  what  he  had  described 
as  the  convalescence  from  his  attacks.  He  reported  that  with  each  dose  of 
the  medicine  from  the  time  of  beginning  its  use  he  had  felt  relief.  The  flatu- 
lence and  ejection  of  sour  fluid  had  ceased  ;  and  on  the  second  day  his  appe- 
tite returned.  He  had  celebrated  the  return  of  it  by  eating  whitebait  and 
spitch-cock  eels,  and  drinking  some  weak  brandy  and  water  at  dinner.  The 
consequence  was  one  attack  of  the  sour  waterbrash ;  but  since  then  he  had 
been  free.  The  urine  had  become  nearly  natural.  On  the  skin  of  the  arms 
and  abdomen  he  showed  me  spots  as  large  as  sixpences  of  a  red  erythematous 
eruption,  closely  resembling  measles.  He  said  it  did  not  itch,  but  pricked, 
like  what  Indians  call  "  the  prickly  heat." 

The  next  day  it  was  still  more  like  measles,  for  the  centre  of  the  spots  had 
begun  to  fade  while  the  circumference  had  spread,  like  fairy-rings  on  the  green 
sward. 


ANALYSIS 


THE  cases  in  this  volume  form  a  sort  of  skeleton,  which  I  have 
articulated  together  by  argument,  and  tried  to  make  muscularly 
act  i  ve  by  practical  observations.  A  list  of  them,  indexed  accord- 
ing to  the  subjects  they  profess  to  illustrate,  will  serve  as  a 
memorandum,  just  as  the  dry  bones  recall  succinctly  the  struc- 
ture of  the  animal  frame  to  the  anatomical  student. 


CllAETER  II. — Indigestion  of  various  Foods. 

?  1.  Of  starch. 

I  and  II. — Flatulence  after  starvation  and  sorrow. 
HI.— To  illustrate  the  action  of  Iodide  of  Potassium  on  the  salivary 

glands. 

«  IAM  IV. —  Flatulence,  &c.,  following  loss  of  appetite  induced  by  disgust  and 
anxiety. 

ml  VI. — Flatulence  and  diarrhea  in  cases  of  Bright's  disease  of 
the  kidneys. 

V  II. — Flatulence  from  disease  of  heart  and  arteries. 
CASK  VIII. — Pain  after  vegetable  food  from  loss  of  nerve-power  induced  by 

bodily  exertion. 
CASE  IX.     A   ute  attack  of  flatulence  and  vomiting  from  bodily  exertion  in  a 

healthy  person. 

Case  X. — The  same.     Flatulence  and  immediate  diarrhoea. 
CASK  XI. — The  same.     IMarrlura  later. 

XII. — Flatulence  recurring  habitually  after  moderate  exertion  in  old 

age. 
CASE  XIII. — Chronic  condition  following  one  bodily  imprudence.    Flatulence 

and  nervousness. 
CASK  XIV. — Flatulence  and  insomnia  from  overstrained  attention  of  mind  in 

a  nervous  in.ui. 

20 


306  ANALYSIS. 

CASE  XV. — Chronic  condition  following  one  mental  shock.  Flatulence,  im- 
potence, red  nose. 

CASE  XVI. — Chronic  condition  from  continued  anxiety.  Flatulence,  emacia- 
tion, weight  after  me^ils. 

CASE  XVII. — Flatulence,  spasmodic  pain,  costiveness,  from  bronchial  catarrh. 
CASES  XVIII,  XIX,  and  XX. — Flatulence,  heartburn,  waterbrash,  diarrhoea, 

from  an  attack  of  epidemic  cholera.     Adhesion  of  the  poison  to  the 

locality.    Evil  of  purgatives. 
CASE  XXI. — Indigestion  from  the  depressing  effects  of  rheumatic  fever.   Pain 

at  epigastrium  after  food. 

CASE  XXII. — Flatulence  and  pain  in  abdomen  after  child-bearing. 

CASE  XXIII. — Weight  at  epigastrium  and  vertigo,  flatulence  and  acidity, 
from  climatic  influences. 

CASE  XXIV. — The  same  producing  hysteria. 

CASE  XXV. — The  deleterious  climatic  influences  are  changes,  rather  than 
continued  depressants.  Resistance  gained  by  use  of  Iron. 

CASE  XXVI. — The  dependence  of  indigestion  on  change  of  weather  a  diag- 
nostic sign. 

CASE  XXVII. — Influence  of  locality.  Flatulence,  nausea,  acidity,  waterbrash, 
emaciation,  when  in  a  malarious  district,  and  not  elsewhere. 

CASE  XXVIII,— Soft  air. 

CASK  XXIX. — Sea  air  and  bathing. 

CASE  XXX. — Chronic  flatulence  after  tropical  dysentery.  Remarks  on 
digestion  in  hot  countries. 

CASE  XXXI. — Effects  on  flatulence  of  abstinence  from  sugar. 

§  2.  Indigestion  of  albumen  and  fibrin. 

CASE  XXXII. — Pain  in  epigastrium  after  meat  during  the  debility  induced 
by  an  acute  fever. 

CASE  XXXIII. — Pain,  nausea,  and  diarrhoea  after  meat  in  an  aphthous  con- 
dition of  mucous  membrane. 

CASE  XXXIV. — Phthisis  pulmonalis.  Weight  at  the  epigastrium  after 
animal  food,  diarrhoea,  emaciation,  relieved  by  Quinine  and  Iron. 

CASE  XXXV. — Fatal  consequence  of  a  mental  shock  in  a  consumptive  who 
could  not  digest  meat. 

OASE  XXXVI. — Vomiting  from  oesophageal  lesion  alleviated  by  anaesthetics. 

CASE  XXXVII. — It  is  the  form  rather  than  the  chemical  constitution  which 
makes  meat  difficult  of  digestion  in  cesophageal  cases.  Fish  easier 
digested  from  its  friability. 

CASE  XXXVIII. — Yet  in  some  stomach  cases  even  the  softest  animal  food 
is  rejected. 


ANALYSIS.  307 

{  3.  Indigestion  of  fat. 

CASE  XXXIX.—  Consumption  fatal  from  loss  of  power  of  assimilating  fat, 

though  the  amount  of  tubercle  moderate. 
CASE  XL.  —  Consumption,  though  advanced,   relieved  by  great   power  of 

assimilating  fat. 
CASE  XLI.  —  Moderate   amount   of  consumption   and  moderate  amount   of 

assimilating  power  balancing  one  another. 
CASE  XLII  and  XLI1I.  —  Renewal  of  fat  assimilation  overcoming  tubercular 

diarrlnra. 

CASE  XLIV.  —  Strumous  dyspepsia  consists  in  the  non-assimilation  of  fat. 
CASE  XLV.  —  Disgust  to  fat  joined  to  defective  assimilation.    The  disease 

induced  by  starvation  in  childhood. 

XL  VI.  —  Importance  of  fat  at  the  period  of  puberty  in  girls. 
\  I.  VII.  —  The  disease  induced  by  over-exertion  of  intellect. 
CASE  XLVIII.  —  Cutaneous  symptoms  of  non-assimilation  of  fat. 

2  4.  Digestion  of  water. 

CASE  XLIX.  —  Osmosis  of  water  through  membranes  defective  from  the 

watery  condition  of  the  blood  in  induced  anaemia. 
L.  —  Osmosis  defective  from  retarded  blood-stream  in  diseased  heart. 

CASE  LI.  —  Osmosis  defective  from  retarded  blood-stream  through  emphy- 
sematous  lungs. 

CASE  LII.  —  Illustrations  of  the  variations  in  the  specific  gravity  and  alka- 
linity of  the  urine  through  the  normal  absorption  of  fluid. 

I  5.  Treatment  of  indigestion  based  on  the  article  of  food  not  digested. 

CASE  LIU.  —  It  must  not  consist  in  entire  omission  of  the  indigested  article 
from  the  dietary.  Scorbutus  from  leaving  off  vegetables  by  medical 
advice. 

CASE  LIV.  —  Purpnra  from  insufficient  vegetable  diet  in  a  hard-working  man. 

CASE  LV.  —  Pain  at  the  epigastrium,  costiveness  and  debility,  from  omitting 
meat.  Amenorrha-a  a  stomach  disease. 

HINTS  ON  DIETK 

$  C.   Treatment  based  on  general  ]mth»!o,ii.-(il  condition  of  indigestion,  as 
used  tt<  t/i>  foregoing  cases.     _/•*/•/;<  r/yr'/j/  (Juinim  n,, 


CHAPTER  III.  —  Habits  of  Social  Life  //</•///<;/  to  Indigestion. 
(The  treatment  is  based  on  their  removal.) 

$  1.  Eattnj  too  little. 
CASK  LVI.  —  Flatulence  in  a  man  over-temperate  on  false  medical  theory. 

L  VII.  —  Emaciation,  flatulence,  hysu-ria,  irregular  pulse,  from  omitting 
meat  in  consequence  of  gastralgia. 


308  ANALYSIS. 

CASE  LYIIT. — Debility,  flatulence,  palpitation  of  the  heart,  intermittent 
pulse,  from  omitting  meat  on  false  medical  theory. 

CASE  LIX. — Mental  depression  and  pain  at  epigastrium  from  religious 
ascetism. 

§  2.  Eating  too  much. 

CASE  LX. — Eating  too  much  not  necessarily  a  vice.     Symptoms  in  a  robust 

woman  of  active  intellect. 

CASE  LXI. — Symptoms  in  a  woman  of  weaker  intellect.    Obesity.    Hysteria. 
CASE  LXII. — Melancholy  in  a  man  from  over-eating  and  not  caring. 
CASE  LXIII. — Caution  against  overloading  the  stomach  afforded  by   the 

sudden  death  of  an  old  man  with  diseased  heart. 
CASE  LXIV. — Excess  producing  sleeplessness  and  emaciation. 
CASE  LXV. — Excess  producing  corpulence  in  spite  of  indigestion. 

2  3.  Sedentary  habits. 

CASE  LXVI. — Sedentary  life  not  productive  of  indigestion  if  proper  dietetic 

habits  be  adopted. 

CASE  LXYII. — Violent  exercise  after  eating  causes  indigestion. 
CASE  LXVIIl. — Even  moderate  exercise  does  so  in  elderly  persons. 

\  4.   Tight  lacing. 

CASE  LXIX. — Indigestion  in  a  growing  girl  from  not  getting  a  new  pair  of 

stays  to  fit  her  growth. 
CASE  LXX. — Chronic  vomiting  in  an  adult  from  bandaging  herself  too  tight 

to  preserve  the  form  after  child-bearing. 

§  5.  Compression  of  epigastrium  by  shoemakers. 

CASE  LXXI. — Incipient  stage.    Pain  in  epigastrium  on  pressure  and  soon 

after  food. 
CASE  LXXII. — A  more  advanced  stage.     Pain  in  epigastrium  increased  by 

pressure  and  immediately  after  food,  eructation,  emaciation,  debility, 

broken  sleep. 

CASE  LXXIII. — Deformity  of  thoracic  parietes. 

CASE  LXXIV. — Final  blow  to  the  stomach.    Ulceration  and  hsematemesis. 

\  6.  Sexual  excesses. 

They  do  not  appear  to  produce  indigestion,  though  accused  of  doing  so. 
CASE  LXXV. — But  indigestion  produces  a  perversion  of  the  sexual  instinct. 

\  1.  Solitude. 

CASE  LXXVI. — Flatulence  and  confusion  of  intellect  when  dining  alone, 

however  temperately. 
CASE  LXXVIL — Vomiting  after  solitary  meals. 


ANALYSIS.  309 

2  8.  Intellectual  exertion. 

CASK  LXXVIII. — Nocturnal  flatulence,  nightmare,  and  seminal  emissions 

from  unwonted  exertion  of  a  moderate  intellect 

I. XX  IX. — This  does  not  happen  in  tough-brained  men:  usually  some 
cause  they  do  not  like  to  own  is  the  origin  of  their  indigestion. 

2  9.  Want  of  employment. 

I. XXX.— The  concentration  of  the  mind  upon  itself  in  blind  people 
exaggerates  internal  sensations. 

I  .X  X  XI. — The  same  happens  in  uneducated  persons  deprived  of  accus- 
tomed employment. 

I  .X  X  X 1 1 . — It  may  be  prevented  by  simple  occupation. 

LXXXI1I. — Peculiar  suspiciousness  of  insane  persons  a  diagnostic 

mark  to  detect  imaginary  pains. 
CASE  LXXX1 V. — Association  with  invalids  deleterious. 

2 10.  Abuse  of  purgatives. 

I. XXXV. — The  habit  may  be  commenced  from  mere  imitation. 
CASE  LXXX  VI. — Gradual  omission  of  purgative  habits  in  those  willing  to 

confess  their  folly. 

CASE  LXXXVI  I. — Physiological  error  of  medical  practitioners  respecting 
mercurials. 

2  11.  Abuse  of  alcohol. 

1  .X  X  X  V  III. — Symptoms  in  obese  persons  (male). 
CASE  I.XXXIX.-MHtto  (female). 

XC. — Occasional  effect  of  a  sudden  change  of  habits  in  elderly  persons. 
i '  \  -  •:  X  <  1 . — Extreme  effects  of  chronic  dram-drinking  on  the  stomach. 

2  12.  Tobacco. 

\  ' ' II  and  XCIII. — KfTccts  of  this  drug  on  the  nervous  system. 
1  V  ami  Xi '  V. — Occasional  effects  on  the  digestive  organs. 

2  13. 
CASE  XCVI. — Induction  of  hysterical  dyspepsia. 

2  14.   Of  i  inn. 

VII.-   Occasional!^  inffoces  vomiting. 

1  X»'VIII. — Chronically  atlrcts  the  .li-.-Uon  of  meat  anil  fat. 

\(  1  X. — Ease  with  which  Opium  nciy  lie  left  off  by  a  resolute  person. 


310  ANALYSIS. 

CHAPTER  IV. — Abdominal  Pains. 

§  1.  Heartburn. 

CASE  C. — From  the  sluggish  stomach  of  old  age. 

CASE  CI. — From  chronic  invalidism,  cured  by  tonics. 

CASES  CII  and  CIII. — Coming   on  late  is  sometimes  represented   as  pain 

before  food. 
CASES  CIV  and  CV. — From  over-sensitiveness  of  stomach  comes  on  earlier, 

and  is  best  treated  by  local  anaesthetics. 
CASE  C"VI. — The  quantity  of  the  meal  makes  little  difference  in  this  form  of 

heartburn. 
TREATMENT  DISCUSSED. 

§  2.  Acidity. 
CASE  CVII. — Explains  what  acidity  is. 

§  3.    Waterbrash. 

CASE  CYIII. — Exhibits  the  principal  features  of  the  disorder  and  the  treat- 
ment. 

CASE  CIX. — Marked  line  of  distinction  between  the  ejection  of  the  contents 
of  the  stomach  and  of  the  oesophagus,  showing  waterbrash  to  be  a 
disease  of  the  latter. 

CASE  CX. — Patient's  suggestion  of  a  name  for  the  disease — "  watery  mouth." 

CASES  CXI  and  CXII. — Waterbrash  from  organic  obstruction. 

CASE  CXIIL— Association  of  waterbrash  and  vomiting. 

*»*  LETTER  about  the  waterbrash  of  oatmeal-eaters. 

CASE  CXIV. — Waterbrash  from  exposure  to  heat. 

CASE  CXV. — With  exudation  of  blood. 

CASE  CXVI. — With  ulcer  of  mucous  membrane. 

CASE  CXVII. — Caused  by  lead  poison.  . 

CASE  CXVIII. — One  of  the  sequelae  of  cholera. 

CASE  CXIX. — Also  of  dysentery. 

CASE  CXX. — Associated  with  pulmonary  consumption. 

CASE  CXXI. — Connection  with  amenorrhrea. 

CASES  CXXII,  CXXIII,  CXXIV,  CXXV.— Though  most  common  in  the 
prime  of  life,  is  not  unknown  among  the  aged. 

CASE  CXXVI. — And  children  may  also  suffer  from  it. 

TREATMENT. 


ANALYSIS.  311 

2  4.  Spasms. 

CASES  CXXVII,  CXXVIII,  CXXIX,   CXXX.— Specimens  of  spasmodic 

stomach-ache  from  insoluble  food  taken  at  irregular  hours. 
CASE  ('XX  X  I. — Occurring  the  morning  after  an  indigestible  dinner. 
CASE  CXXXII. — Accompanied  by  muscular  cramps. 
CASE  CXXXII  I. — Arising  from  flatulence  in  a  dram-drinker. 
CASE  CXXX IV. — Abdominal  neuralgia  from  malarious  poison. 

2  5.  Gripes  evacuating  the  stomach. 
\  \  XV. — In  pulmonary  consumption  a  very  bad  symptom. 
CASES  CXXXVI  and  CXXXVIL— With  chronic  lesion  and  healthy  lungs 

not  so  bad. 

CASE  ('XX  X  VIII. — The  relation  of  the  bowels  in  these  cases  not  always  im- 
mediate. 

2  6.    Weight  at  the  stomach  (sometimes  called  "  oppression,"  "  distension," 
and  "tightness  at  the  chest"). 

CASE  CXXXIX. — Case  referring  its  origin  to  excess  of  mucus  on  the  gaStric 
parietes.  (Adherent  pericardium.) 

CASE  CXL. — (Valvular  lesion  of  heart.) 

CASE  CXLI. — (Functional  disturbance  of  heart.) 

CASE  OXLII. — The  dependence  of  this  collection  of  mucus  on  climatic  in- 
fluences. 

CASC  CXLIII. — Its  occasional  connection  with  flatulence. 

CASE  CXLIV.— With  costiveness. 

CASE  CXLV. — Leads  to  hypochondriasis  and  oxaluria. 

CASE  CXLVI. — The  hypochondriasis  is  apt  to  take  a  form  suggested  by 
the  situation  of  the  discomfort. 

CASK  CXLVI  I. — Distinction  drawn  between  weight  and  heartburn. 

CASE  CX  LV1II. — They  may  occur  together. 

2  7.   Wearing  pain. 

CASE  CXLIX. — From  structural  lesion  caused  by  exposure  to  high  tem- 
perature. 

CASK  CL. — The  same  caused  by  poor  living.    Use  of  Opium. 
CASE  CLI. — The  same  from  external  adhesions  probably. 
CASE  CLIL— Effects  of  hot  food. 

CLIII. — Effects  of  damp  climate.     Pain  increased  by  motion. 

CLIV. — Pain  increased  by  motion  and  by  tonic  drugs. 


312  ANALYSIS. 

CASE  CLV. — Wearing  pain  caused  by  pressure  on  the  abdomen,  too  spare 

diet,  and  over-exertion.    Vomiting  of  blood. 
CASE  CLVI. — Joined  to  waterbrash  and  bloody  vomiting. 
CASE  CLYII. — Joined  to  bloody  vomiting. 
CASE  CLVIII. — With  hemorrhage  from  the  bowels. 
CASE  CLIX. — With  bloody  vomiting.     Symptom  of  pain  in  the  back. 

§  8.  Soreness  on  pressure. 
Conjectured  to  denote  structural  lesion  of  tissue. 

§  9.  Anomalous  pains  in  the  epigastrium. 
CASES  CLX  and  CLXI. — Dysmenorrhcea. 
CASE  CLXII. — Indigestion  producing  imitation  of  renal  colic. 
CASE  CLXIII. — Epigastric  pain  from  voluntary  constipation. 

CHAPTER  Y. —  Vomiting. 

§  1.  General  remarks  on  the  physiology  of  the  process. 

\  2.   Vomiting  of  pus. 

CASE  CLXIV. — From  purulent  lesion  of  sub-oesophageal  tissue. 
CASE  CLXV. — From  a  malignant  tumor  of  the  throat. 

CASE  CLXVI. — From  the  same  attached  to  the  cardiac  portion  of  the 
stomach. 

\  3.  Vomiting  of  mucus. 

CASE  CLXVII. — In  English  cholera  or  acute  summer  gastric  disorder. 
CASE  CLXVIIL— In  bilious  attacks. 
CASES  CLXIX  and  CLXX. — These  are  worse  when  joined  to  diarrhoea,  and 

are  not  likely  therefore  to  be  mended  by  purgatives. 
CASE  CLXXI. — A  more  chronic  form. 
CASE  CLXXII. — Which  is  sometimes  a  symptom  of  consumption. 

§  4.   Vomiting  of  blood. 

CASES  CLXXIII  and  CLXXIV. — Cases  exhibiting  the  accompanying  symp- 
toms in  ordinary. 

CASE  CLXXV. — Symptoms  of  imminent  fatal  result. 

CASES  CLXXVI  and  CLXXVII.— The  same,  though  not  actually  fatal,  in 
old  persons. 

CASES  CLXXVIII  to  CLXXXII. — Recurrence  of  haematemesis  at  various 
intervals  from  one  year  to  twelve. 


ANALYSIS.  318 

Various  aspect  of  the  blood  thrown  out : 
In  streaks,  CASE  CLX  X  I  ; 
In  a  gush,  CASES  CLX  X  I  V .  (  1  .X  X  I X  : 
In.  /  masses,  CASE  CI.XX  XIII; 

Partially  digested  into  a  brou-njl>(i<l.  CASE  CLXXXIV; 
Green,  CASE  CLXXXV; 
As  black  stools,  CASE  CLX  X  X  V I . 

CASE  (.'I.X  XX  VII. — Risk  of  the  blood  draining  away  by  the  bowels  instead 

of  by  stomach. 

CASE  CLX  X  X  VIII. — The  two  symptoms  usually  joined. 
1          " '  I  .X  X  X I X. — Conjunction  of  waterbrash  and  hsematemesis. 
CASE  CXC. — Illustration  of  the  slight  violence  needful  to  break  the  gastric 

bloodvessels. 
CASE  CXCI. — Haematemesis  from  congestion  of  the  neighboring  viscera. 

2  5.  Acid  fermentation  of  vomit. 

CASES  CXCII  to  CXCV. — Cases  illustrative  of  the  symptoms  accompany- 
ing it. 

2  6.  Fecal  vomiting. 

The  discussion  of  this  is  considered  not  fairly  to  belong  to  the  subject  of  in- 
digestion. 

\  7.   Vomiting  of  unchanged  food,  and  hysterical  vomiting. 
'          ' '  \  < '  V I  .—Chewing  the  cud  partially  voluntary. 

\  i '  V  1 1 . — Vomiting  induced  by  the  catamenial  period, 
i          t  •  \  i  •  v  1 1 1. — Vomiting  arrested  by  the  occurrence  of  the  catamenia. 

'          i  'X'  IX.— Vomiting  without  hysteria  or  any  uterine  disturbance  cut 
short  l>y  Valerian. 

—Arrest  of  acute  functional  vomiting  by  withdrawal  of  all  food, 
i  VI. — The  same  in  a  more  chronic  instance. 
('('II. — The  same,  Mood  being  also  thrown  up. 

1          <  VI 1 1.— Kfl'i-rts  of  the  shower-baths.  Hereditary  nature  of  this  disease. 
CASE  CCIV. — Effects  of  strong  mental  imjires-ion  in  causing  and  curing  the 

disease. 

<          CCV. — Association  of  functional  vomiting  with  functional  paralysis  of 
Other  parts  illustrates  the  true  physiology  of  the  a«-t. 

1          (,'CVI. — Throwing  up   of  food   from   mechanical  impediments  to  its 
descent. 


314:  ANALYSIS. 

*          §  8.   Vomiting  in  Pulmonary  Consumption. 
CASE  CO  VII. — In  slight  degree. 

CASE  CCVIII. — The  degree  of  dyspepsia  and  degree  of  tuberculosis  are  not 
proportioned  to  one  another. 

CASE  CCIX. — Sickness  dependent  on  debility.  Use  of  Cod-oil  and  Hypo- 
phosphite  of  Lime  compared. 

CASES  CCX  and  CCXI. — Early  vomiting  in  consumption.  Use  of  Opium  in 
small  doses. 

CASE  CCXII. — Use  of  Opium  in  large  doses  in  the  vomiting  of  advanced 

consumption. 
CASE  CCXIII. — Vomiting  in  advanced  consumption  from  the  nauseousness  of 

the  sputa  difficult  to  be  remedied. 

§  9.  Occasional  Causes  of  Chronic  Vomiting. 

CASE  CCXIV. — Uraemia  and  not  dropsy  is  the  cause  of  it  in  Bright's  disease. 
CASE  CCXV. — Emphysema. 
CASE  CCXVL— Ditto.    Vomiting  at  night. 
CASE  CCXVII. — Marsh  malaria. 
CASE  CCXVIIL— Worms. 
CASE  CCXIX.— Shock. 

CASE  CCXX. — Alcoholism.     Oxide  of  Zinc  as  a  remedy. 
CASE  CCXXI. — Poisoning  by  Arsenic. 
CASE  CCXXII. — Repugnance  to  food,  want  of  appetite. 

§  10.  Sea-sickness. 

CASE  CCXXIII. — The  pathological  condition  does  not  always  cease  with  its 

motive  cause,  but  may  induce  acute  illness  afterwards. 
CASE  CCXXIV. — It  may  bring  on  chronic  vomiting. 

CHAPTER  VI. — Flatulence. 

CASE  CCXXV. — Fatal  impediments  to  diaphragm  caused  by  flatulence. 
CASE  CCXXVI. — Impediment  to  motion  of  heart  causing  irregular  pulse. 
CASE  CCXXVII. — Intestinal  flatulence  in  fat  women. 
CASE  CCXXVIII. — Flatulence   cured  by  the   direct  renewal   of  digestive 

solvent. 

CASE  CCXXIX. — Direct  relief  of  flatulence  by  absorption  of  the  collected  gas. 
CASE  CCXXX. — Cure  by  Strychnine  and  Iron. 


ANALYSIS.  315 

CHAPTERS  VII  and  VIII,  on  Diarrhoea,  Constipation  'and 
CostivenesSj  are  not  illustrated  by  Cases. 

CHAPTER  IX. — Nerve  Disorders  connected  unth  Indigestion. 

CASE  CCXXXI. — Sick-headache  arising  from  mental  causes  cured  by  leaving 
off  purgatives  and  taking  Quinine  and  Taraxacum,  in  a  gouty  man. 

K  XXII. — Sick-headache  in  a  weakly  woman. 

1          CCXXXIII. — The  same  with  erythema  nodosum. 

CASE  CCXXXIV. — Headache  causing  alarm  of  apoplexy. 

CASE  CCXXXV. — Long-ingrained  headache  cured  by  Strychnine  and  Quinine. 

CASE  CCXXXVI. — Hemicrania  in  such  cases  an  evidence  of  improvement. 

CASE  CCXXXVII. — Occupation  of  the  whole  head  an  evidence  of  the 
contrary. 

CASE  CCXXXVIII. — Purgatives  aggravate  the  disease. 

CASES  CCXXXIX  and  CC  XL. — Gastric  vertigo  also  aggravated  by  purga- 
tives. 

CASES  CCXLI  and  CCXLII. — Difference  of  this  vertigo  and  that  produced  by 
alcohol. 

CASE  CCXLIII. — Addled  brain  and  addled  stomach. 

CASK  ('('X  U  V. — Vertigo  and  mental  helplessness. 

CASK  CCXLV. — Strong  epileptic  fit  from  undigested  food  in  a  healthy  child. 

CASE  CCXLVI. — Mild  chronic  epilepsy  from  chronic  morbid  condition  of 
alimentary  canal. 

CASES  CCXLVII  and  CCXLVIIL— The  same.    Cure  by  dietetic  discipline. 

CASE  CCXLIX. — Incurable  epileptic  fits  preceded  by  flatulence  and  dis- 
tension. 

CASE  CCL. — Choreic  spasms. 

CASK  CCLI. — Stomach  cough  in  phlegmatic  temperament. 
CASE  CCLII. — Stomach  cough  in  a  gouty  diathesis,  alternating  with  the  pains. 
CASE  CCLIII. — The  same  coinciding  with  the  pains. 
CASK  O'l.I  V. — Anaesthesia. 
1C  ASK  CCLV.— Paralysis. 
CASE  CCL VI. — Atrophy  of  muscles. 
CASE  CCLV  1 1.— Flushing  of  face. 

*  CCLVIII  and  CCLIX.— Nottlorash. 
CCLX. — Erythema  circumscriptum  from  indigestion  in  a  gouty  person. 


ALPHABETICAL    INDEX 


TO 


THE  COMMENTARY. 


Acid  and  alkaline  dyspepsia,  144 
medicinal  use  of,  14<>,  147 
physiological  use  of,  76,  136,  144 
"Acidity,"  144,211 
Acute  acid  dyspepsia  of  Chomel,  148 
Acute  and  chronic,  their  essential  dif- 

ference, 22 

Albumen,  indigestion  of,  53 
Alcohol,  abuse  of,  121,  233,  279 
Alkali,  medicinal  use  of,  135,  140,  142, 

liil.  1>;2.  2-1 

physiological  use  of,  73,  76 
Alkaline  fluid  of  waterbrash,  148 
Anieiiorrlid'a  due  to  stomach,  1'J 
An.-i-sthesia,  14'»,  298 
Arsenic,  injurious  effect  of,  233 
Ascetism,  95 

ilation  the  path  of  cure,  21,  56,63 
Atrophy  of  muscles,  107,  2U9 

Back,  sensations  in  the,  177,  179,  189 
Bathinir,  cold,  120.  I'M.  14.:.  22<>,  280 
Beef-t  ;or  making,  84 

,  258 

.omitiiK  of.  ln<),  197 
Bilious  attacks,  198 

diarrhnvi. 
Bilion- 

liisniutli.  niedii-inal  use  of,  196,  224 
Bloodleitin 

.   vomiting,  109,  156,  201 
in.-.  :<"! 

230 


Carbonic  acid,  medicinal  use  of,  14".  142 

physiological  u-e  of,   241 
Catamenia,  connection  of,  with  diges- 

ti-i,  ilHi.  217 

Catarrh  of  the  stomach,  171.  J98, 

•al,  m.'diriiKil  i; 

Cheese,  toasted,  86 


Cholera,  chronic  effects  of,  44,  270 
cramps  in,  105 
stools,  204 

Chronic  and  acute,  their  essential  dif- 
ference, 22 
Classification  of  forms  of  indigestion, 

27,  29,  77,  139,  149 
Climate,  effects  of,  48,  174 
Cod-liver  oil,  preparation  for  the  use  of, 

89 

"  Coffee-ground"  vomit,  206 
Constipation,  190,  272 
Contagiousness  of  hysteria,  223 
Cookery,  82,  155,  169 
Cooks,  indiiiestion  in,  155,  159 
Constructive  remedies,  90 
Corpulence,  74.  80 
Costiveness,  275 

a  consequence  of  purgation, 

.  278,  2b7 
Cough,  gastric,  296 

Definition  of  constipation,  272 

COStiVrllr- 

eczema,  71  (note) 
flatulence.  SI,  211 
heartburn 
hysteria,  34 
indigestion,  18,  25 
vital  arts.  I4.'i 

Deformities  from  pressure .  li'l.  In;) 
•ui -live  remedies,  42,   11'.'.  12" 

Miarrhu-a  and  emaciation,  17i> 
forms  of. 

Dietetics,  SI,  li!2,  178,  268 

Dilatation  of  stomach,  122 

Dram-drinkim:.  death  from,  124 

Dy-eutery,  effects  of,  158 

X  too  little. 

much.    !'7,  163,  171 
Emaciation  following  excess,  101 


318 


ALPHABETICAL    INDEX. 


Emphysema  pulmonum  as  a  cause  of 

indigestion,  75,  230 
Epilepsy,  71,292 
Erythema  nodosum,  284 

circumscriptum,  303 
Exercise,  excess  of,  38,  163 
too  little,  102 

Fasting,  94 

Fecal  vomiting,  215 

Female  figure,  proportions  of,  106 

Fermentation,  44,  48,  211,  252,  290 

Fetor  of  sputa,  nausea  from,  227 

Flatulence,  166,  241 

Fluids,  indigestion  of,  90 

Gastric   catarrh.     See    Catarrh   of  the 

Stomach, 

Gluttony,  92,  163 
Green  vomit,  (198,  206 
Gripes,  167 

Habits  leading  to  indigestion,  92 

Hce.matem.esis.     See  Bloody  vomiting. 

Hsematoxylum,  170 

Heartburn,  134 

Heart  disease,  a  cause  of  indigestion, 

37,  74,  171,  174 
as  affected  by  indiges- 
tion, 99 

Hemicrania,  286 

Hereditary  tendency  to  hysteria,  221 
Homoeopathy,  23,  119 
Hunger,  35,  138 

Hydrocyanic  acid,  use  of,  140,  174,  239 
Hydropathy,  118,  162,  280 
Hypochondriasis,  98,  162,  248,  277 
Hysteria,  34,  98,  216,  291 

Idleness,  113 

Inanition,  31 

Insanity,  diagnosis  of,  117 

Insurance,  selection  of  lives  for,  125 

Iodide  of  Potassium,  33,  91,  137 

Iron,  use  of,  90,  141,  143,  161,  284 

Kino,  use  of,  161 

Lacing,  tight,  103 
Lead-poison,  68,  156,  157,  208 
Lieutery,  168 

Liquorice  in  heartburn,  141 
Liver,  action  of  reagents  on,  256 

Malaria  productive  of  stomach-ache,!  66 

vomiting,  231 
Masturbation,  107,  111 
Mercurials,  41,  90,  120,  174,  255 
Milk,  83 
Mind,  action  of  digestion  on,  98,  291 

on  digestion,  30,  31, 42,  70, 
112,  237,  277,  283 


Mineral  waters,  142 
Mucous  diathesis,  48,  51 

membranes,  alternation  of  dis- 
eases of,  173 

function  of  51  (note) 
Muscular  fibre,  indigestion  of,  58,  83 
Mutton,  encomium  on,  86 

Nerve  disorders,  282 
Nettle-rash,  287,  302 

Oatmeal-eaters,  waterbrash  of,  154 
(Esophagus,  how   affected   by  disease, 
31,  58,  135,  148,  193,  222 

ulcer  of,  195,  196 
Old  age,  40 
Oleaginous  food,  indigestion  of,  52,  59 

necessity  for,  63,  80,  82 
Oleaginous  medicines,  63 
Opium,  pernicious  effects  of,  131,  248 

medicinal  use  of,  133,  185,  227, 

239,  267,  269 
Osmosis,  laws  of,  73 
Oxalate  of  lime  in  urine,  176 
Oxide  of  zinc,  140,  233 
Oysters,  87, 162 

Pain  necessarily  joined  to  pleasure,  78 
Pancreas,  disease  of,  66,  72 
Pancreatic  emulsion,  72,  90 
Paralysis,  299 
Pastry,  anatomy  of,  82 
Pepsine,  medicinal  use  of,  87,  235,  269 
Periodicity  of  vomiting,  204 
Phthisical  indigestion,  5(J,  158, 168,  201, 

225 

Piles,  259,  274 
Pregnancy, 234 
Pressure,  soreness  on,  187 
Puberty,  influence  of,  on  digestion,  67 
Purgatives,  40,  46,  80,  119,  199,  267, 

278,  286,  287 
Pus,  formation  of,  171, 197 
vomiting  of,  195 

Quinine,  general  use  of,  90,  178,  253 
given  without  acid,  167 

Rest,  easiest  obtained  in  double  organs, 

22 
importance  of,  in  the  treatment  of 

disease,  55,  218,  300 
Rheumatic  fever,  55 
Roasting,  encomium  on,  85 

Saliva,  physiological  action  of,  30 

changes  in,  91 
Sarcina  ventriculi,  171,  212 
Schools,  cautions  respecting,  110,  119 
Scurvy  easily  induced,  78 
Sea-air  and  bathing,  50 


ALPHABETICAL    INDEX. 


319 


Sea-sickness,  235 
Shoemakers'  indigestion,  1»7 

upright  bench. 

Shoulders,  paiu  between,  177,  180 
Sick-headache,  282 
Skin  affections,  71,  284,  287,  302,  303 
Snuff.  !•_'•; 
Solitude,  111 

Spasm  induced  by  atony,  162,  164 
Spasmodic  stomach-ache,  162,  237 
Spermatorrhoea,  176,  24'J 
Stages  of  digestion,  27 

ion  of,  29 

Starvation,  31,  92,  240 
St  ruinous  indigestion,  65 

iiiiiue,  precautions  in  use  of,  91 

indigestion  of,  30,  52 
Sulphate  of  copper,  157, 169,  170 

Tea,  misuse  of,  129 

Temperature,  as  a  remedy,  120,  143 

Tobacco,  125 


Treatment  based  on  article  indigested, 

77 

pathological   con- 
dition, 90 

Urine,  aa  affected  by  digestion,  76 

Valerian,  use  of,  191,  218,  253 

Vegetables,  importance  of,  in  diet,  78 

Venereal  excess,  110 

Vertigo,  288 

Violence  as  a  cause  of  vomiting,  209, 

231 

Vital  acts,  145 
Vomiting,  physiology  of,  192 

Waterbrash,  148,  209 
Water,  indigestion  of,  73 

medicinal  use  of,  143,  188,  256, 

279 

"Wearing"  pain,  179 
Weight  at  epigastrium  interpreted,  171 


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(LATE  LEA  t  BLANCHARD's) 


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HENRY  C.  LEA'S  PUBLICATIONS — (Dictionaries). 


TTlUNGLISQN  (ROBLEY],  M.D., 

"^  Professor  of  Institutes  of  Medicine  in  Jefferson  Medical  College,  Philadelphia. 

MEDICAL   LEXICON;   A  DICTIONARY   OF  MEDICAL  SCIENCE:   Con- 
taining a  concise  explanation  of  the  various  Subjects  and  Terms  of  Anatomy,  Physiology, 
Pathology,  Hygiene,  Therapeutics,  Pharmacology,  Pharmacy,  Surgery,  Obstetrics,  Medical 
Jurisprudence,  and  Dentistry.     Notices  of  Climate  and  of  Mineral  Waters;   Formulae  for 
Officinal,  Empirical,  and  Dietetic  Preparations;  with  the  Accentuation  and  Etymology  ot 
the  Terms,  and  the  French  and  other  Synonymes;  so  as  to  constitute  a  French  as  well  as 
English  Medical  Lexicon.    Thoroughly  Revised,  and  very  greatly  Modified  and  Augmented 
In  one  very  large  and  handsome  royal  octavo  volume  of  1048  double-columned  pages,  in 
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with  this  view,  the  immense  demand  which  has  existed  for  the  work  has  enabled  him,  in  repeated 
revisions,  to  augment  its  completeness  and  usefulness,  until  at  length  it  has  attained  the  position 
of  a  recognized  and  standard  authority  wherever  the  language  is  spoken.     The  mechanical  exe- 
cution of  this  edition  will  be  found  greatly  superior  to  that  of  previous  impressions.    By  enlarging 
the  size  of  the  volume  to  a  royal  octavo,  and  by  the  employment  of  a  small  but  clear  type,  on 
extra  fine  paper,  the  additions  have  been  incorporated  without  materially  increasing  the  bulk  of 
the  volume,  and  the  matter  of  two  or  three  ordinary  octavos  has  been  compressed  into  the  space 
of  one  not  unhandy  for  consultation  and  reference. 


It  -would  be  a  work  of  supererogation  to  bestow  a 
word  of  praise  upon  this  Lexicon.  We  can  only 
wonder  at  the  labor  expended,  for  whenever  we  refer 
to  its  pages  for  information  we  are  seldom  disap- 
pointed in  finding  all  we  desire,  whether  it  be  iu  ac- 
centuation, etymology,  or  definition  of  terms. — New 
York  Medical  Journal,  November,  1865. 

It  would  be  mere  waste  of  words  in  us  to  express 
our  admiration  of  a  work  which  is  so  universally 
and  deservedly  appreciated.  Th»  most  admirable 
work  of  its  kind  in  the  English  language.  As  a  book 
of  reference  it  is  invaluable  to  the  medical  practi- 
tioner, and  in  every  instance  that  we  have  turned 
over  its  pages  for  information  we  have  been  charmed 
by  the  clearness  of  language  and  the  accuracy  of 
detail  with  which  each  abounds.  We  can  most  cor- 
dially and  confidently  commend  it  'to  our  readers. — 
Glasgow  Medical  Journal,  January,  IStitj. 

A  work  to  which  there  is  no  equal  in  the  English 
language. — Edinburgh  Medical  Journal. 

It  is  something  more  than  a  dictionary,  and  some- 
thing less  than  an  encyclopaedia.  This  edition  of  the 
well-known  work  is  a  great  improvement  on  its  pre- 
decessors. The  book  is  one  of  the  very  few  of  which 
it  may  be  said  with  truth  that  every  medical  man 
should  possess  it. — London  Medical  Times,  Aug.  26, 
1863. 

Few  works  of  the  class  exhibit  a  grander  monument 
of  patient  research  and  of  scientific  lore.  The  extent 
of  the  sale  of  this  lexicon  is  sufficient  to  testify  to  its 
usefulness,  and  to  the  great  service  conferred  by  Dr. 
Kobley  Duuglison  on  the  profession,  and  indeed  on 
others,  by  its  issue. — London  Lancet,  May  13,  1665. 

The  old  edition,  which  is  now  superseded  by  the 
new,  has  bei.-n  universally  looked  upon  by  the  medi- 
cal profession  as  a  work  of  immense  research  and 


It  is  undoubtedly  the  most  complete  and  useful 
medical  dictionary  hitherto  published  in  this  country. 
— .(Jhicayo  Med.  Examiner,  February,  l»6o. 

What  we  take  to  be  decidedly  the  best  medical  dic- 
tionary in  the  English  language.  The  present  edition 
is  brought  fully  up  to  the  advanced  state  of  science. 
For  many  a  long  year  "Dnnglison"  has  been  at  our 
elbow,  a  constant  companion  and  friend,  and  we 
greet  him  in  his  replenished  and  improved  form  with 
especial  satisfaction.— Paei/ie  Med.  and  Sura.  Jour- 
nal, June  27,  1S6.3. 

This  is,  perhaps,  the  book  of  all  others  which  the 
physician  or  surgeon  should  have  on  his  shelves.  It 
is  more  needed  at  the  present  day  than  a  few  years 
back. — Canada  Med.  Journal,  July,  1865. 

It  deservedly  stands  at  the  head,  and  cannot  be 
surpassed  in  excellence. — Buffalo  Med.  and  Surg. 
Journal,  April,  1865. 

We  can  sincerely  commend  Dr.  Dunglison's  work 
as  most  thorough,  scientific,  and  accurate.  We  have 
tested  it  by  searching  its  pages  for  new  terms,  which 
have  abounded  so  much  of  late  in  medical  nomen- 
clature, and  our  search  has  been  successful  in  every 
instance.  We  have  been  particularly  struck  with  the 
fulness  of  the  synonymy  and  the  accuracy  of  the  de- 
rivation of  words.  It  is  as  necessary  a  work  to  every 
enlightened  physician  as  Worcester's  English  Dic- 
tionary is  to  every  one  who  would  keep  up  his  know- 
ledge of  the  English  tongue  to  the  standard  of  the 
present  day.  It  is,  to  our  mind,  the  most  complete 
work  of  the  kind  with  which  we  are  acquainted. — 
Boston  Med.  and  Surg.  Journal,  June  22,  1865. 

We  are  free  to  confess  that  we  know  of  no  medical 
dictionary  more  complete ;  no  one  better,  if  so  well 
adapted  for  the  use  of  the  student;  no  one  that  may 
be  consulted  with  more  satisfaction  by  the  medical 


great  value.     The  new  has  increased  usefulness ;  for  |  practitioner.— Am.  Jour.  Med.  Sciences,  April,  1S65. 
medicine,  in  all  its  branches,  has  been  making  such        _, 

progress  that  many  new  terms  and  subjects  have  re-        The  ™lne  of 'he.  Present  edition  has  been  greatly 
v     °,     , s^i_        j.  _n  _*  — u;_u    '   — i f j   I  enhanced   bv  the  introduction   of   new  suhienfs  anil 


oentlybeen  introduced:  all  of  which  maybe  found  I  enhanced  by  the  introduction  of  new  subjects  and 
fully  denned  in  the  present  edition.     We  know  of  no  |  terms.  audLa  mo™  complete  etymology  and  accentua- 


For  many  years  Dunglison's  Dictionary  has  been  i  be  w^^}  ^.—St.  Louis  Med.  and  Surg.  Journal, 
the  standard  book  of  reference  with  most  practition-  \  APr">  1Sba- 

«rs  in  this  country,  and  we  can  certainly  commend  I  It  has  the  rare  merit  that  it  certainly  ha*  no  rival 
this  work  to  the  renewed  confidence  and  regard  of  !  in  the  English  language  for  accuracy  and  extent  of 
•ur  readers. — Cincinnati  Lancet,  April,  1S65.  I  references. — London  Medical  Gazette. 


fJOBLYN  (RICHARD  D.),  M.D. 

A  DICTIONARY  OF  THE  TERMS  USED  IN  MEDICINE  AND 

THE  COLLATERAL  SCIENCES.  A  new  American  edition,  revised,  with  numerous 
additions,  by  ISAAC  HAYS,  M.  D.,  Editor  of  the  "American  Journal  of  the  Medical 
Sciences."  In  one  large  royal  12mo.  volume  of  over  500  double-columned  pages;  extra 
cloth,  *1  50  ;  leather,  $2  00. 

It  is  the  best  book  of  definitions  we  have,  and  ought  always  to  b«  upon  the  stadaut's  table. — Southern 
Med.  and  Surg.  Journal. 


HENRY  C.  LEA'S  PUBLICATIONS — (Manual*). 


(JOHN),  M.D.,    and      (3M1TU  (WiANClS  <?.),  M.D., 

W     Pro/  ;f  thf.  fnst  it  ittr*  "f  MrdMnr.  in  the  Phfw.  of  Penna. 

AN     ANM.YTICAL    COMI'KMHr.M    OF    TIIK    VARIOUS 

BRA  r  the  Use  and  Examination  of  Student*.     A 

new  edition,  rex  i-rd  and  improved.     In  one  wry  large  anil  handsomely  printed  royal  12mo. 
volume.  oi  ai.oir  ,inl  p:ipren,  with  374  wood  cuU,  extra  cloth,  $4;  strongly  bound 

ID  leather,  with  rai.-ed  bands,  (I 

h  in  incompara-  >  than  l.noo  pages  Is  an  Impossibility,  but  we  think  that 
bly  the  in. -t  r»lu*,  n»  approaches  as  near  to  it  ««•- 

•  •oiuitry     Attempt*  b»Te  be.-n  nude  in  various  ,  »tble.     Altogether,  It  U  the  be*t  of  UK  clas*,  and  ban 
-  juevxe  Au»-  •  with  a  dei^rved  success.    A*  an  elementary  text- 

its  been  useful,  and  will  con- 
ia  ttie,  examination  of  private 

i'ily  failed  in  '  all  ap  to  t1.  '!   often  be  referred  to  by  the 

•  f  "Xeill  and  Smith  :, try  practitioner. —  Vn.  MeA.  Journal. 

a  »atr<i'  '>«•  of  the  w'n  AH  a  handbook  for  students  tt  Is  Invaluahle,  eon- 

.iirn  and  illuttrated,  and  ihi-  'uing  in  the  rao»t  condensed  form  th«  eslabllnhed 

••J  to  the  ^  I    principled  of  medldne  and  ita  collateral 

.1  of  every  elasn.— *V.  0.  Mea.  and  bury.    hcieuco<(- — 4v.  y/  Juurual  qf  MctJticiM. 

popnlar  farorlte  with  the  .Indent  U  so  well  \      '»  *he  rapid  eonr»*  of  leetoro.,  where  work  for  the 
kn,.wn  tl,!,.  it  r«,nlr^  n»  mor*  at  the  hands  of  TJ".  and  renew  peoMaary  for  an  exa- 

tnediral  editor  than  the  annunciation  of  a  new  »:  '"  1:"'  ' 

•    in  no  uort  of  compare 
.  and  any  other  on  a  -uu:lar  )> 

'bj-t-u*.  y, , ./  .v  SJ^IT.!::^:        .r  ts"£ 

There  aro  but  few  8»udent»  or  practitioners  of  me-     r.lverlM  are  explicitly,  though  con«i«ely,  laid  befcra 

dicln.  rlth  the  foi  M-I-  edition-,  of  |J  , ,,-  C(,ttr(!e  it  i»  n»el«w»  for  us  to  recom- 

.mid«  though   hinbly  instrnctive  work.      TIIH     „„.„,](;;  ..lonU.  but  tli.-re  in  a  clans 

.ire  been  sifted,     to  wh,.m  we  rei  |.  hook 

1  Dorado,  and  the  pw-    M  W0rth  1U  weight  In  •ilver— that  cUuw  U  U»e  gr»du- 

tiou-  .11  tine  little  volume.   A  co  .  J-  medicine  of  more  than  ten  years'  xtauding. 

P'eiT  ":     who  have  not  studied   medicine  blnce.      Tl,- 

LMV  nuK-  u  in.-  c,.u>taut  poek«t  companion.—  West-  '  psrhaP»  find  out  from  it  that  the  ncience  U  not  ex- 
•m  Lancet.  \  aciiy  now  what  it  was  when  they  left  it  off. — Th* 

T\>  compress  the  whole  science  of  medicine  In  less  '  8tetno»c<tjie. 


JJARTSHORNE(HBNRY\t  M.  /'.. 

.xor  of  Uyijien.e  in  ilie  Univtraity  of  Pennsylvania. 

A  CONSPKCTTS  OF  TIIK   MKIUCAL  SCIENCES; 

Handbook.1)  on    Antitmny,    Wiytiology,   C!ieini>try,   M;»teria    Medic:i,    Prnctical   Medicine, 
In  imc  hirjxc  rnynl  12mo.  volume  of  nearly  1000  closely  printed 
pager,  with  about  3()0  illustration?  on  wood.     (Nearly  Rf/>.'i/.) 

Tim  nhility  of  the  author,    and  hi*  jaiu-tiiM!   skill  in  condensation,  give  assnmnc*  that  thi- 
work  will  jirnvt-  vnlualilo  not  unly  t»  th-  student  jirej.jiring  for  examination,  but  also  to  the  j.r:ii*- 
titiont-r  de-irmi<  ot"  ,,\ .hiinini;  within  n  ino.ler.at.>  c"in|i.is-,  a  view  of  the  existing  condition  of  the 
It  department*  of  science  connected  wilh  medicine. 


TUDLO\V(J.  L.).  .)/.  It., 


A    MANTAL   OF    RXAMINATIOXS    ujmn    Anatorny, 

Pnrpery.    Prnrtice   of  Medicine,  Obstetric?,    '  .    I'liannacy,  and 

Theni|»-iitir--.  To  which  is  added  a  Medical  Fortnuliiry.  Third  edition,  thoroughly  revised 
and  greatly  extended  un<l  enlnrged.  With  .'!7n  illu^trntions.  In  one  handsome  royal 
IJmo.  volume  of  816  large  pages,  extra  cloth,  $3  25;  leather,  $3  75. 

The  arrangement  of  tlii.<  volume  in  the  form  of  question  and  answer  renders  it  especially  suit- 
able for  the  office  examination  of  students,  and  for  those  preparing  fur  graduation. 

We  know  of  no  hetlei^impanlon  for  the  student  '  "f  the  student  In  prrparin1-*  f  >r  hi*  final  examination, 
durin.-  •  "t  uitlif  !• 

y  kind 
•rnrnmi 
whom  he  i»  '  .  IT  »f 

A«  It  e»»>r  •  ,»-dical   ntudien  . 

it  U  neeemarily   TO  itaininp   Klij   large 

duodecimo  page*.      Afier  a  comewliat  can-fn 


inform   him- 


of  it-  i-  ,nt.-nt-s  w«-  )I:»VH  tunned  a  much   more 
fcrornt'  •'.  it  than  w. 

»•!.  I.  works.  Although  well  adapted  to  meet  t: 


nelf  on  »oy  aubject.  and  w: 

:<!!'«•••  .uiproved  — St.   A"H»>   Jf«rt. 

Surg.  Journal. 


rr. \\SKR   (TllfMAS  HA  \\  A" /•>•].  J/  f).. 

A   M  A\T  LL  OF  CLINICAL  MKhlciNK  AND  TUVSICAL  DIAG- 

-IS.  Third  AmnriiMin,  from  the  cecond  enlarged  and  revised  English  edition.  To 
which  is  added  The  Code  of  Ethics  of  the  American  Medical  Association.  In  one  huoa- 
some  volume  12rao.  (Preparing  for  ear{y  publication.) 


HENRY  C.  LEA'S  PUBLICATIONS — {Anatomy}. 


QR AY  (HENRY),  F.R.S., 

Lecturer  on  Anatomy  at  St.  Gnvrgda  Hospital,  London. 

ANATOMY,    DESCRIPTIVE    AND    SURGICAL.      The  Drawings  by 

II.  V.  CARTER,  M.  D.,  late  Demonstrator  on  Anatomy  at  St.  George's  Hospital;  the  Dissec- 
tions jointly  by  the  AUTHOR  and  DR.  CARTER.  Second  American,  from  the  second  revised 
and  improved  London  edition.  In  one  magnificent  imperial  octavo  volume,  of  over  800 
pages,  with  388  large  and  elaborate  engravings  on  wood.  Price  in  extra  cloth,  $6  00  ; 
leather,  raised  bands,  $7  00. 

The  author  has  endeavored  in  this  work  to  cover  a  more  extended  range  of  subjects  than  is  cus- 
tomary in  the  ordinary  text-books,  by  giving  not  only  the  details  necessary  for  the  student,  but 
also  the  application  of  those  details  in  the  practice  of  medicine  and  surgery,  thus  rendering  it  both 
a  guide  for  the  learner,  and  an  admirable  work  of  reference  for  the  active  practitioner.  The  en- 
gravings form  a  special  feature  in  the  work,  many  of  them  being  the  size  of  nature,  nearly  all 
original,  and  having  the  names  of  the  various  parts  printed  on  the  body  of  the  cut,  in  place  of 
figures  of  reference,  with  descriptions  at  the  foot.  They  thus  form  a  complete  and  splendid  series, 
which  will  greatly  assist  the  student  in  obtaining  a  clear  idea  of  Anatomy,  and  will  also  serve  to 
refresh  the  memory  of  those  who  may  find  in  the  exigencies  of  practice  the  necessity  of  recalling 
the  details  of  the  dissecting  room;  while  combining,  as  it  does,  a  complete  Atlas  of  Anatomy,  with 
a  thorough  treatise  on  systematic,  descriptive,  and  applied  Anatomy,  the  work  will  be  found  of 
essential  use  to  all  physicians  who  receive  students  in  their  offices,  relieving  both  preceptor  and 
pupil  of  much  labor  in  laying  the  groundwork  of  a  thorough  medical  education. 

Notwithstanding  its  exceedingly  low  price,  the  work  will  be  found,  in  every  detail  of  mechanical 
execution,  one  of  the  handsomest  that  has  yet  been  offered  to  the  American  profession ;  while  the 
careful  scrutiny  of  a  competent  anatomist  has  relieved  it  of  whatever  typographical  errors  existed 
in  the  English  edition. 

Thus  it  is  that  book  after  book  makes  the  labor  of '  and  with  scarce  a  reference  to  the  printed  text.  The 
the  stndeat  easier  than  before,  and  since  we  have  ,  surgical  application  of  the  various  regions  is  also  pre- 
Eeen  Blanchard  &  Lea's  new  edition  of  Gray's  Ana-  sented  with  force  and  clearness,  impressing  upon  the 
toray,  certainly  the  finest  work  of  the  kind  now  ex-  i  student  at  each  step  of  his  research  all  the  important 
tant,  we  would  fain  hope  that  the  bugbear  of  medical  j  relations  of  the  structure  demonstrated. — Cincinnati 
students  will  lose  half  its  horrors,  and  this  necessary  j  Lancet. 

foundation  of  physiological  science  will  be  much  fa-  j      This  is,  we  believe,  the  handsomest  hook  on  Aea- 

tomy  as  yet  published  in  our  language,  and  bids  fair 
to  become  in  a  short  time  THE  standard  text-book  of 


cilitated  and  advanced. — N.  0.  Jtled.  Ifeios. 

The  various  points  illustrated  are  marked  directly 
on  the  structure ;  that  is,  whether  it  be  muscle,  pro- 
cess, artery,  nerve,  valve,  etc.  etc. — we  say  each  point 
is  distinctly  marked  by  lettered  engravings,  so  that 
the  student  perceives  at  once  each  point  described  as 
readily  as  if  pointed  out  on  the  subject  by  the  de- 
monstrator. Most  of  the  illustrations  are  thus  ren- 


our  colleges  and  studies.  Students  and  practitioners 
will  alike  appreciate  this  book.  We  predict  for  it  a 
bright  career,  and  are  fully  prepared  to  endorse  the 
statement  of  the  London  Lancet,  that  "We  are  not 
acquainted  with  any  work  in  any  language  which 
e«u  take  equal  rank  with  the  one  before  us."  Paper, 
printing,  binding,  all  are  excellent,  and  we  feel  that 


dered  exceedingly  satisfactory,  and  to  the  physician  |  a  grateful  profession  will  not  allow  the  publishers  to 
they  serve  to  refresh  the  memory  with  great  readiness;  go  unrewarded. — Kashville  lied,  and  Surg.  Journal. 


s 


'MITH  (HENR  Y  H.},  M.D.,         and     TJORNER  (  WILL1A M  E.),  M.D., 

Pro/,  of  Surgery  in  the  Univ.  of  Penna.,  &c.  Late  Prof,  of  Anatomy  in  the  Univ.  ofPenna.,Ac- 

AN    ANATOMICAL    ATLAS,  illustrative   of  the   Structure  of  the 

Human  Body.     In  one  volume,  large  imperial  octavo,  extra  cloth,  with  about  six  hundred 
and  fifty  beautiful  figures.     $4  50. 


The  plan  of  this  Atlas,  which  renders  it  so  pecu- 
liarly convenient  for  the  student,  and  its  superb  ar- 
tistical  execution,  have  been  already  pointed  out.  We 
must  congratulate  the  student  upon  the  completion 
of  this  Atlas,  as  it  is  the  most  convenient  work  of 


the  kind  that  has  yet  appeared ;  and  we  must  add, 
the  very  beautiful  manner  in  which  it  is  "got  up" 
is  so  creditable  to  the  country  as  to  be  flattering  to 
our  national  pride. — American  Medical  Journal. 


TJDRNER  (WILLIAM  E.),  M.D., 

SPECIAL  ANATOMY  AND  HISTOLOGY.    Eighth  edition,  exten- 

sively  revised  and  modified.     In  two  large  octavo  volumes  of  over  1000  pages,  with  more 
than  300  wood-cuts;  extra  cloth,  $6  00.  0 


&HARPEY  (WILLIAM],  M.D., 


and       Q  VAIN  (JONES  £  RICHARD}. 
HUMAN  ANATOMY.   Revised,  with  Notes  and  Additions,  by  JOSEPH 

LBIDV,  M.D.,  Professor  of  Anatomy  in  the  University  of  Pennsylvania.     Complete  in  two 
large  octavo  volumes,  of  about  1300  pages,  with  511  illustrations;  extra  cloth,  $6  00. 
The  very  low  price  of  this  standard  work,  and  its  completeness  in  all  departments  of  the  subject, 
should  command  for  it  a  place  in  the  library  of  all  anatomical  students. 


A  LLEN  (J.  if.),  M.D. 
THE  PRACTICAL  ANATOMIST ;  OR,  THB  STUDENT'S  GUIDE  IN  THE 

DISSECTING  ROOM.     With  266  illustrations.     In  one  very  handsome  royal  12mo.  volume, 
of  over  600  pages;  extra  cloth,  $2  06. 
Oae  of  the  most  useful  works  upon  the  subject  ever  written. — Hudical  Examin* 


HF.NRY  C.  LEA'S  PUBLICATIONS — (Anatomy). 


(Eli  A  F.R.S. 

A  SYSTEM   or   IM'MAN    ANATOMY.  Gfertttl  *fed  SpetiaL     A  new 

and  revised  Am.-i  icun,  from  the  last  and  en!  -h  edition.     Kdited  by  W.  H.  Go- 

BRKniT.  .Ml>.  1'r.  it  --or  of  Ueneral  and  Sin  uy  in  the  Medicxl  College  of  Ohio. 

Illu.-trati-d  with  tin.  «•  hundred  and  ninety-seven  engravings  on  wood.     In  one  large  and 

•tavo  volume,  of  over  600  large  pages;  extra  cloth,  $4  00;  leather,  $5  00. 

The  publisher  trust*  that  the  well-earned  reputation  of  this  long-established  favorite  will  be 
more  than  maintained  l>y  the  present  edition.  Besides  a  very  thorough  revision  by  the  author,  it 
has  been  most  carefully  examined  by  the  editor,  and  the  efforts  of  both  have  been  directed  to  in- 
troducing everything  which  increased  experience  in  its  use  has  suggested  as  desirable  to  render  it 
a  complete  •  foe  those  seeking  to  obtain  or  to  renew  an  acquaintance  with  Human  Ana- 

tomy. The  ,-1111011111  of  additions  which  it  has  thus  received  may  be  estimated  from  the  fact  that 
the  present  edition  contain*  over  one-fourth  more  matter  than  the  last,  rendering  &  smaller  type 
and  an  enlarged  page  requisite  to  keep  the  volume  within  a  convenient  sire.  The  author  has  not 
only  thus  added  largely  to  the  work,  but  he  has  also  made  alterations  throughout,  wherever  there 
appeared  the  opportunity  of  improving  the  arrangement  or  style,  so  as  to  present  every  fact  in  its 
most  appropriate  manner,  and  to  render  the  whole  as  clear  and  intelligible  as  possible.  The  editor 
has  exercised  the  utim.-t  caution  to  obtain  entire  accuracy  in  the  text,  and  has  largely  increased 
the  number  of  illu«trati.  n*.  of  which  there  are  about  one  hundred  and  fifty  more  in  this  edition 
than  in  the  last,  thus  bringing  distinctly  before  the  eye  of  the  student  everything  of  interest  or 
importance. 
JDY  THE  SAMK  ATTJI'iR. 

THE  DISSECTOR'S   MANUAL;   OR,  PRACTICAL  AXD  SURGICAL  ANA- 

TOUT.  Third  American,  from  the  last  revised  and  enlarged  English  edition.  Modified  and 
rearranged  by  WILLIAM  HOST,  M.  D.,  late  Demonstrator  of  Anatomy  in  the  University  of 
Pennsylvania.  In  one  large  and  handsome  royal  12mo.  volume,  of  582  pages,  with  154 
illu.-tr.it ions;  extra  cloth,  $2  00. 


ETo/xv/vs.  (RICHARD  ^f.).  M.D., 

•*•  •*•  Lsttr  DfiHiiHttrntor  ></  Anatomy  in  thr  Jf<vlir<il  Department  of  Hnrmrd  Un(rcr«ity. 

PRACTICAL    I'fSSKCTIONS.     Second  Edition,  thoroughly  revised.     In 

one  neat  royal  12ino.  volume,  half-bound,  $2  00.     (Just  Issntd.) 

The  object  of  this  work  ig  to  present  to  the  anatomical  student  a  clear  and  concise  description, 
of  that  which  he  is  expected  to  observe  in  an  ordinary  course  of  dissections.  The  author  has 
endeavored  to  omit  unnecessary  d«.-tuils,  and  to  present  the  subject  in  the  form  which  many  years' 
experience  has  shown  him  to  be  the  most  convenient  and  intelligible  to  the  student.  In  the 
revision  of  the  present  edition,  he  has  sedulously  labored  to  render  the  volume  more  worthy  of 
the  favor  with  which  it  has  heretofore  been  received. 


.\ri.i<K  (jf 

SUK.'H'AL    ANATOMY.      P,y  J..SKPH    MACLI>K.  Surgeon.     In  one 

volume,  very  large  imperial  quarto;  with  fitf  large  and  splendid  plates,  drawn  in  the  best 
style  ami  beautifully  colored,  containing  190  figures,  many  of  them  the  site  of  life;  together 
with  copious  explanatory  letter-press.  Strongly  and  handsomely  bound  in  extra  cloth. 
Price  f  14  00. 

Ai  no  complete  vv<.rk  of  the  kind  has  heretofore  been  published  in  the  English  language,  the 
'  volume  will  supply  a  want  long  felt  in  this  country  of  an  accurate  and  comprehensive- 
Atlas  of  Surgii-al  Anatomy,  to  which  the  student  and  practitioner  can  at  all  times  refer  to  ascer- 
tain the  exact  relative  positions  of  the  various  portions  of  the  human  frame  towards  each  other 
and  to  the  surface,  as  well  as  their  abnormal  deviations.  The  importance  of  such  a  work  t<>  the 
student,  in  the  absence  of  anatomical  material,  and  to  practitioners,  either  for  consultation  in 

emer<_-  r  r Uections  of  the  dissecting  room,  is  evident.     Notwithstanding 

fhe  large  size,  beauty  anil  finish  of  the  very  numerous  illustrations,  it  will  be  observed  that  the 

i*  so  low  as  to  place  it  within  the  reach  of  all  members  of  the  profession. 

We  know  of  no  work  on  Mirgical  anatomy  which     r.-'t.  -ti.-.i    by   tli"- •    clear  an. I   dl«tlnct   £tiuw>etions, 
•an  compete  with  it. — hincet.  winch  every  one  ::.  • 

The  work  of  Slaclim?  on  surgical  anatomy  1*  of  the  I  °  '  '""I'*-"  i'iv«.>  h..-   j<    :.. 

kixhnxt  value.     lu  >  •  publl- | ' 

••(Ion  of  it-  kind  w  .        ,UJ  in  worthy  of  I  * 

place  In  the  libmry  of  any  medical  man,  v  '"  u'y  of  lite 

•indent  con  ,k'e  a  better  luve»tin<>ut  than  .  !oi"1Xr>"  :ineatloK  Hi.  rhan- 

M*.—l%lW*timJ'o*r»alafM*dicine<in<lX><r<,.ri/      >""'  "f  ''"•  h""'»"  body,  are  i.ivn,,t  (>,  examine  our 

iipecimen  copy.     IT  anything  will  induce  nar(<>oiui 


N«  «nrh  lithofrrmphic   Illustration*  of  lurglral  re- 
|ioo«  hare  hitherto,  wo  think,  bwn  ni»en.     While 


and  Htndents  to  patronize  a  book  >>f  i>ucii  IA 
and  ev.  r  :.un-.«  (<•  ill. -in.  it  will  be  u 


the  operator  It  «bo'  «•>!  and  nerre  where     of  ihe  »rti-tic;i  e«  ui 

>:ion  in  coateiupU;e<i,  Hie  txact  aUHlomixt  In     nntnrv — H  g  J**riu>l. 


PEASI.KK  (K.  R.}.  M.It.. 
rr<<frt*vr  .tfAtn!  .[iriulofy  in  Dartmouth  3t«d.  ColUgt,  .V  // 

IIT'MAN    IMST«»I.oi;v.  in  its  n-hiUoiis  f>  Anatumy, 

Pathology;   for  the  use  of  medical  students.     With   Tour  hundred  and  tbir!y-fm::  .'.,*• 
tious.     la  one  handsome  octavo  volum*  of  «rer  tiOD  pages,  extra  cloth.     $3  75. 


8 


HENRY  C.  LEA'S  PUBLICATIONS — (Physiology). 


MARSHALL  (JOHN],  F.  R.  S. 

Professor  of  Surgery  in  University  College,  London,  Ac. 

OUTLINES  OF  PHYSIOLOGY,  HUMAN  AND  COMPARATIVE. 

With  Additions  by  FRANCIS  QDRSKV  SMITH,  M.  D.,  Professor  of  the  Institutes  of  Medi- 
cine in  the  University  of  Pennsylvania,  <fee.  With  numerous  illustrations.  In  one  large 
and  handsome  octavo  volume,  of  1026  pages,  extra  cloth,  $6  50  j  leather,  raised  bands, 
$7  50.  (Now  Ready.) 


We  may  now  congratulate  him  on  having  com- 
pleted the  latest  as  well  as  the  best  summary  of  mod- 
ern physiological  science,  both  human  and  compara- 
tive, with  which  we  are  acquainted.  To  speak  of 
this  work  in  the  terms  ordinarily  used  on  such  occa- 
sions would  not  be  agreeable  to  ourselves,  and  wonld 
fail  to  do  justice  to  its  author.  To  write  such  a  book 
requires  a  varied  and  wide  range  of  knowledge,  con- 
siderable power  of  analysis,  correct  judgment,  skill 
in  arrangement,  and  conscientious  spirit.  It  must 
have  entailed  great  labor,  but  now  that  the  task  has 
been  fulfilled,  the  book  will  prove  not  only  invaluable 
to  the  student  of  medicine  and  surgery,  but  service- 
able to  all  candidates  in  natural  science  examinations, 
to  teachers  In  schools,  and  to  the  lover  of  nature  gene- 
rally. In  conclusion,  We  can  only  express  the  con- 
viction that  the  merits  of  the  work  will  command  for 
it  that  success  which  the  ability  and  vast  labor  dis- 
played in  its  production  so  well  deserve. — London 
Lancet,  Feb.  22,  1S68. 

If  the  possession  of  knowledge,  and  peculiar  apti- 


tnde  and  skill  in  expounding  it,  qualify  a  man  to 
write  an  educational  work,  Mr.  Marshall's  treatise 
might  be  reviewed  favorably  without  even  opening 
the  covers.  There  are  few,  if  any,  more  accomplished 
anatomists  and  physiologists  than  the  distinguished 
professor  of  surgery  at  University  College  ;  and  he 
has  long  enjoyed  the  highest  reputation  as  a  teacher 
of  physiology,  possessing  remarkable  powers  of  clear 
exposition  and  graphic  illustration.  It  is  only  re- 
markable that  Mr.  Marshall  has  allowed  so  long  & 
time  to  elapse  before  producing  a  text-book  after  his 
own  heart.  The  plan  of  this  book  differs  in  many 
respects  from  that  of  existing  educational  books; 
the  science  of  human  physiology  being  treated  in 
wider  and  more  constant  reference  to  chemistry, 
physics,  and  comparative  anatomy  and  physiology. 
There  can  be  no  question,  we  think,  that  this  is  the 
most  satisfactory,  philosophic,  and  fruitful  mode  of 
teaching  physiology.  We  have  rarely  the  pleasure 
of  being  able  to  recommend  a  text-book  so  unreserv- 
edly as  this.—  British  Mtd.  Journal,  Jan.  23,  1868. 


CARPENTER  (WILLIAM  B.},  M.D.,  F.R.S., 

Examiner  in  Physiology  and  Comparative  Anatomy  in  the.  University  of  London. 

PRINCIPLES  OF  HUMAN  PHYSIOLOGY;  with  their  chief  appli- 

cations  to  Psychology,  Pathology,  Therapeutics,  Hygiene  and  Forensic  Medicine.  A  new 
American  from  the  last  and  revised  London  edition.  With  nearly  three  hundred  illustrations. 
Edited,  with  additions,  by  FRANCIS  GURNET  SMITH,  M.  D.,  Professor  of  the  Institutes  of 
Medicine  in  the  University  of  Pennsylvania,  <tc.  In  one  very  large  and  beautiful  octavo 
volume,  of  about  900  large  pages,  handsomely  printed;  extra  cloth,  $5  50  ;  leather,  raised 
bands,  $6  50. 


The  highest  compliment  that  can  be  extended  to 
this  great  work  of  Dr.  Carpenter  is  to  call  attention 
to  this,  another  new  edition,  which  the  favorable 
regard  of  the  profession  has  called  for.  Carpenter  is 
the  standard  authority  on  physiology,  and  no  physi- 
cian or  medical  student  will  regard  his  library  as 
complete  without  a  copy  of  it. — Cincinnati  Med.  Ob- 
server. 

With  Dr.  Smith,  we  confidently  believe  "that  the 
present  will  more  than  sustain  the  enviable  reputa- 
tion already  attained  by  former  editions,  of  being 
one  of  the  fullest  and  most  complete  treatises  on  the 
subject  in  the  English  language."  We  know  of  none 
from  the  pages  of  which  a  satisfactory  knowledge  of 
the  physiology  of  the  human  organism  can  be  as  well 
obtained,  none  better  adapted  for  the  use  of  such  as 
take  np  the  study  of  physiology  in  its  reference  to 
the  institutes  and  practice  of  medicine. — Am.  Jour. 
Jled.  Sciences. 


We  doubt  not  it  is  destined  to  retain  a  strong  hold 
on  public  favor,  and  remain  the  favorite  text-book  in 
our  colleges. — Virginia  Medical  Journal. 

We  have  so  often  spoken  in  terms  of  high  com- 
mendation of  Dr.  Carpenter's  elaborate  work  on  hu- 
man physiology  that,  in  announcing  a  new  edition, 
it  is  unnecessary  to  add  anything  to  what  has  hereto- 
fore been  said,  and  especially  is  this  the  case  since 
every  intelligent  physician  is  as  well  aware  of  the 
character  and  merits  of  the  work  as  we  ourselves  are. 
— St.  Louis  Med.  and  Surg.  Journal. 

The  above  is  the  title  of  what  is  emphatically  the 
great  work  on  physiology;  and  we  are  conscious  that 
it  would  be  a  useless  effort  to  attempt  to  add  any- 
thing to  the  reputation  of  this  invaluable  work,  and 
can  only  say  to  all  with  whom  our  opinion  has  any 
influence,  that  it  is  our  authority. — Atlanta  Mett. 
Journal. 


B 


Y  THE  SAME  AUTHOR. 


PRINCIPLES  OF  COMPARATIVE  PHYSIOLOGY.    New  Ameri- 

can,  from  the  Fourth  and  Revised  London  Edition.     In  one  large  and  handsome  octavo 
volume,  with  over  three  hundred  beautiful  illustrations     Pp.  752.    Extra  cloth,  $5  00. 
As  a  complete  and  condensed  treatise  on  its  extended  and  important  subject,  this  work  becomes 

a  necessity  to  students  of  natural  science,  while  the  very  low  price  at  which  it  is  offered  places  it 

within  the  reach  of  all. 

f>Y  THE  SAME  AUTHOR. 

THE  MICROSCOPE  ANT>   ITS  REVELATIONS.     Illustrated   by 

four  hundred  and  thirty-four  beautiful  engravings  on  wood.     In  one  large  and  very  hand- 
some octavo  volume,  of  724  pages,  extra  cloth,  $5  25. 


JT'IRKES  (WILLIAM  SENHOUSE),  M.D., 

A  MANUAL  OF  PHYSIOLOGY.     A  new  American  from  the  third 

and  improved  London  edition      With  two  hundred  illustrations.     In  one  large  and  hand- 
some royal  12nio.  volume.     Pp.  586.     Extra  cloth,  $2  25 ;  leather,  $2  75. 

It  is  at  once  convenient  In  size,  comprehensive  in  lent  guide  in  the  study  of  physiology  in  its  most  ad- 
design,  and  concise  in  statement,  anil  altogether  well  vanced  and  perfect  form.  The  author  has  shown 
adapted  for  the  purpose  designed. — St.  Louis  lied,  himself  capable  of  giving  details  sufficiently  ample 
and  Surg.  Journal.  in  a  condensed  and  concentrated  shape,  on  a  science 

in  which  it  is  necessary  at  once  to  be  correct  and  not 
The  physiological  reader  will  find  it  a  must  excel-     leugthoued. — Edinburgh  Med.  and  Surg.  Journal. 


HENRY  C.  LEA'S  PUBLICATIONS — (Physiology). 


J)ALTON(A  C.),  M.D., 

•U  Profettor  of  Phytiultigy  in  the  College  of  Phytician*  and  8urffton»,  ltev>  York,  Ac. 

A  TltKATISK  ON    1M.MAN    I'll  VSKH.OGY,  Desi^n-l  for  the  use 

of  Students  and  Practitioner?  of  Medicine.  Fourth  edition.  re\i-ed.  with  nearly  three  hun- 
dred il!u-tr:ii  i..iM  on  wood.  In  one  very  beautilul  octavo  volume,  of  about  700  pages,  extra 
cloth,  $5  25;  leather,  $6  25.  (.Jntt  t&ud.) 

''ttfm. 

!••  by  Physiology  and  the  kindred  Science*  during  the  last  few  years  has  r*- 
••"••nt  edition   (•'  -i  thorough  and  extensive  revision.     This  progress 

-i"tfd  in    :i:  di-i-ovrrie*.  nor  in  a  •  !  hition  in   any  of . 

the  'I  !iiin  been  marked   by  great  activity  of  investigation  in  a 

multitude  of  different  directions,  the  combined  result*  of  which  have  not  failed  to  impress  a  new 
character  on  many  of  the  feuluit  "logical  knowledge.  ...  In  the  revision  mid 

correrti.iM  of  the  present  edition,  the  author  baa  endeavored  to  incorporate  all  s«ch  improve- 
ments in  physiological  knowledge  with  the  mass  of  the  text  in  such  a  manner  as  no*  essentially 
to  alter  the  structure  and  plan  of  the  work,  so  far  as  they  have  been  found  adapted  to  the  wants 
and  convenience  of  the  reader.  .  .  .  Several  new  illuiUrations  are  introduced,  some  of  them 
ag  additions,  others  as  improvements  or  -  of  the  old.  Although  all  parte  of  the  book 

have  received  more  or  less  complete  revision,  the  greatest  number  of  additions  and  changes  were 
required  in  the  Second  Section,  on  the  Physiology  of  the  Nervous  System." 

Advent  of  the  first   edition  of  Prof    Pulton's  i  merits  of  clearness  »nd  condensation,  and  being  fully 

Phyrtologv,  about  eight  year*  ago,  marked  a  new  em    brought  np  to  the  present  level  of  Physiology,  it  i* 

In  the  study  of  ph\  :  dly  one  of  the  most   reliable  text-book* 

iful   ni:in:i.  ••_•  ,.tl      upon  thin  science  that  could  be  placed  in  the  hands 

science  threw  off  the  long,  lo,,-.  .rments    ,,i  the  medic*!  student.— Am.  Journal  Jfed  Sciences, 

«biliiy  and  surmise,  in  which  it  had  been  ar-    Oct.  1»07. 
rayed  by  ni'.-t  arti-tn,  and  came  among  UK  Minim.: 

and  atiractive,  in  the  beautifully  tinted  and  clouely       rr<>f-  Dalton'»  work  ha*  such  a  well-established 

fitting  di.-»s  of  a  demo:.-  eputatton  that  it  doe*  not  »tand  in  need  of  any  re- 

AS  a  result  of  erudition  aud    commendation.    Ever  »iuc-  its  first  appearance  it  baa 

if.  Dalt.m  to  pnwent  to  tlie  world    become  the  highest  authority  iu  tie  English  language; 

awur-.  'iry  at  once  brief,  pointed,  aud  com-    a"J  ''la:  luaintain  the  enviable  p 

iid  which  exhibited  plainly  in  letter  aud     whirl,  it  ha>  ui  d  exhaustion  of  the  dif- 

drawingi  the  ba»i«  upon  which  the  conclusions  itr-  '•'"•nt  suci'e^ive  editions  U  sufficient  evidence.  The 
riv.-d  ai  n-i.  d  It  is  no  disparagement  of  the  many  present  edition,  which  is  the  fourth,  has  been  tho- 
excellent  works  on  physiology,  published  prior  to  roughly  revi.-.-d,  and  enlarged  by  the  incorporation 


that  of  Dxlton,  to  say  that  none  of  them,  either  in 
phin  of  iirr.iii.'-iii-Mit  or  clearne»«  of  execution,  could 
be  compared  with  his  for  the  use  of  students  or  gene- 
ral practitionerK  of  uiediriuo.  For  this  purpose  hi* 
book!  nglish  language.  —  Wetltrn, 

Journal  nf  Jletiicin • 

A  capital  toxt-book  in  every  way.     We  are,  there- 

•  ••  it  ID  :t-  fourth edltina.   It  has  already 

been  examined  at  full  length  iu  th>>-e  columns,  go  that 

we  need  not  now  further  advert  to  it  bevond  reranrk- 


of  M|!  the  many  important  advances  which  have 
lately  been  made  in  ihis  rapidly  progressing  science. 
—A.  r.  M.-l  li»;ir.l,  Oct.  l.\  1867. 

As  It  stands,  we  esteem  it  the  very  best  of  the  phy- 
siological text-books  for  the  stndent.  and  the  most 
concise  reference  and  guide-book  for  the  practitioner. 
— .V  r.  Mett.  Journal,  Oct.  1867. 

The  prcment  edition  of  this  now  standard  work  f  ally 
xu-taiiis  the  high  reputation  of  iu  accomplished  au- 
thor. It  in  not  merely  a  reprint,  but  has  been  fiiith- 


ing  that  In.th  rerision  and  enlargement  have  been  j  f,,||y  revli«ed,  an. I  em  ..-h  additions  an  the 

us.— London  lied.   Timet  a*d  Qatette,    ,,,  ,  ha*  rendered  de»iri«ble    Taken 

-I  r.-liableaod 

Wo  Letter   proof  of  the  value  of  this  admirable  '  useful  ti  it  hnn  been  issued 

work  i  lured  than  the  fact  that  it  ha«  »1-    from   the  American  pros*.— Chicago  Jted.  Journal, 

'  ready  reached  a  fourth  edition  in  the  short  -;  -      :    1867. 

•irs.     Po»»ei>iiing  in  an  eminent  degree  the  ' 


J)f\f;f./^>\    ROSLET),  M.  D., 

•U  Pr<-f-  in  Jffferffm  Jf^Hml  Oollrfff,  PhHtut'1 

IM'.MAN    I'lIVSloLOUV.     Ki-hth  .Million.     Thoroughly  revised  and 

extensively  modified  and  enlarged,  with  five  hundred  and  thirty-two  illustrations.     In  two 
•••  and  handsomely  printed  octavo  volumes  of  about  1500  pages,  extra  cloth.     $7  00. 


j  /://.]/.  i.vA'(c.  G.) 

J  I'll  VSIOI.OCK'AL  rilKMISTKV.     TranslMli-l  from  tlu-  second  r.li- 

ti-n  hv  (IEOKOK  K    Dvv,  M    !•  .  K    K   S.,  A<-.,  edited  l.y  H.  K.  ROGERS,  M   1>  ,  I'n.te-nr  ..f 
i«try  in  the  Medieal  hejiMrnn.-nt  ..('the  I'liiver-ity  ..t   I'.  :  with  il!u.-ti. 

•in  Fiuike's  Atla-  ..I  1'.  Clieini-try.  and  IIM  Appendix  of  plates.      (  "in 

plete  in  t«  'jontuining  12UU  i>;i^««,  with  nearly  two 

hundred  illu.-trution.-,  extra  clutli.      $(•  I'll. 


nr  TUK  .s.rv/-: 

V.  \\r\I.   OF    CHEMICAL    I'll  VSlOl.Oli  V.     Tr:in-l:i1.'.l   from   the 

liernmn,  with  \                        :  liiinn.,  l,y  .1    Cut  -I,,N    M..KI;!-,  M    !>  ,  with   an  Introdui-tory 

»rn.  JACK<'I\.  M    !>..  nf  the  I'ni  .  •  vnsyl- 

'^'ith  iliu-trati..ii-  1.11  wi.ii.l.      In  une  \ery  hnn  !  |'Uge« 
extra  cloth.     ^ 

D  (uor>i-:i;r  r,^.  M.H.  /•-.;;..<.,  a,,,i  j~>n  \VMA.\-  .  }\:\.  r.i: 

TI1K    rUVSIOLocirAF,    ANATOMY    AND    I'll  VSK  »!,(  >•  ;  V    OF 

M  \N.      With  ahniit  tli-eo  hutnlrfd  larjre  nnd   heaiitiful  illustrations  on  wood.      Complete  in 
one  large  octavo  volume  of  'JaO  page*,  extra  cloth.     Price  $4  H. 


10 


HENRY  C.  LEA'S  PUBLICATIONS — {Chemistry}. 


(  WM.  T.),  D.  C.L.,  and   BAYLOR  (ALFRED  £),  M.D.,  F.R.S. 
CHEMISTRY.     Second  American  edition,  thoroughly  revised  by  Dr. 

TAYLOR.     In  one  handsome  8vo.  volume  of  764  pages,  extra  cloth,  $5  00  ;  leather,  $6  00. 
(Just  Issued.) 

FROM  DR.  TAYLOR'S  PREFACE. 

"The  revision  of  the  second  edition,  in  consequence  of  the  death  of  my  lamented  colleague, 
has  devolved  entirely  upon  myself.  Every  chapter,  and  indeed  every  page,  has  been  revised, 
and  numerous  additions  made  in  all  parts  of  the  volume.  These  additions  have  been  restricted 
chiefly  to  subjects  having  some  practical  interest,  and  they  have  been  made  as  concise  as  possible, 
in  order  to  keep  the  book  within  those  limits  which  may  retain  for  it  the  character  of  a  Student's 
Manual  "—London,  June  29,  1867. 


A  book  that  has  already  so  established  a  reputa- 
tion, as  has  Brande  and  Taylor's  Chemistry,  can 
hardly  need  a  notice,  save  to  mention  the  additions 
and  improvements  of  the  edition.  Doubtless  the 
work  will  long  remain  a  favorite  text-book  in  the 
schools,  as  well  as  a  convenient  book  of  reference  for 
all.—  N.  Y.  Medical  Gazette,  Oct.  12,  1867. 

For  this  reason  we  hail  with  delight  the  republica- 
tion,  in  a  form  which  will  meet  with  general  approval 
and  command  public  attention,  of  this  really  valua- 
ble standard  work  on  chemistry — more  particularly 
as  it  has  been  adapted  with  such  care  to  the  wants  of 
the  general  public.  The  well  known  scholarship  of 
its  authors,  and  their  extensive  researches  for  many 
years  in  experimental  chemistry,  have  been  long  ap- 
preciated in  the  scientific  world,  but  in  this  work  they 
have  been  careful  to  give  the  largest  possible  amount 
of  information  with  the  most  sparing  use  of  technical 
terms  and  phraseology,  so  as  to  furnish  the  reader, 
"whether  a  student  of  medicine,  or  a  man  of  the 
world,  with  a  plain  introduction  to  the  science  and 
practice  of  chemistry." — Journal  of  Applied  Ohem- 
istry,  Oct.  1S67. 


This  second  American  edition  of  an  excellent  trea- 
tise on  chemical  science  is  not  a  mere  repnblication 
from  the  English  press,  but  is  a  revision  and  en- 
largement of  the  original,  under  the  supervision  of 
the  surviving  author,  Dr.  Taylor.  The  favorable 
opinion  expressed  on  the  publication  of  the  former 
edition  of  this  work  is  fully  sustained  by  the  present 
revision,  in  which  Dr.  T.  has  increased  the  size  of 
the  volume,  by  an  addition  of  sixty-eight  pages. — Am. 
Journ.  Aled.  Sciences,  Oct.  18t>7. 

THE  HANDBOOK  ix  CHEMISTRY  OP  THE  STUDENT.— 
For  clearness  of  language,  accuracy  of  description, 
extent  of  information,  and  freedom  from  pedantry 
and  mysticism,  no  other  text-book  comes  into  com- 
petition with  it. — The  Lancet. 

The  authors  set  out  with  the  definite  purpose  of 
writing  a  book  which  shall  be  intelligible  to  any 
educated  man.  Thus  conceived,  and  worked  out  in 
the  most  sturdy,  common-sense  method,  this  book 
gives  in  the  clearest  and  most  summary  method 
possible  all  the  facts  and  doctrines  of  chemistry. — 
Medical  Times. 


JftOWMAN  (JOHN  E.),M.  D. 


PRACTICAL  HANDBOOK  OF  MEDICAL  CHEMISTRY.    Edited 

by  C.  L.  BLOXAM,  Professor  of  Practical  Chemistry  in  King's  College,  London.  Fourth 
American,  from  the  fourth  and  revised  English  Edition.  In  one  neat  volume,  royal  12mo., 
pp.  351,  with  numerous  illustrations,  extra  cloth.  $2  25. 


The  fourth  edition  of  this  invaluable  text-book  of 
Medical  Chemistry  was  published  in  England  in  Octo- 
ber of  the  last  year.  The  Editor  has  brought  down 
the  Handbook  to  that  date,  introducing,  as  far  as  was 
compatible  with  the  necessary  conciseness  of  such  a 
work,  all  the  valuable  discoveries  in  the  science 


which  have  come  to  light  since  the  previous  edition 
was  printed.  The  work  is  indispensable  to  every 
student  of  medicine  or  enlightened  practitioner.  It 
is  printed  in  clear  type,  and  the  illustrations  are 
numerous  and  intelligible. — Bo&ton  Mud.  and  Surg. 
Journal. 


>r  THE  SAME  AUTHOR. 


INTRODUCTION   TO   PRACTICAL  CHEMISTRY,  INCLUDING 

ANALYSIS.     Fourth  American,  from  the  fifth  and  revised  London  edition.     With  numer- 
ous illustrations.     In  one  neat  vol.,  royal  12mo.,  extra  cloth.     $225.     (Just  Issued.) 


One  of  the  most  complete  manuals  that  has  for  a 
•long  time  been  given  to  the  .medical  student. — 
Athenceum. 

We  regard  it  as  realizing  almost  everything  to  be 
•desired  in  an  introduction  to  Practical  Chemistry. 


It  is  by  far  the  best  adapted  for  the  Chemical  student 
of  any  that  has  yet  fallen  in  our  way. — British  and 
Foreign  Medico-Chirurgical  Review. 

The  best  introductory  work  on  the  subject  with 
which  we  are  acquainted.—  Edinburgh  Monthly  Juur. 


S7RA  HA  M  ( THOMAS),  F.  R.  S. 
THE   ELEMENTS   OF    INORGANIC    CHEMISTRY,  including  the 

Applications  of  the  Science  in  the  Arts.  New  and  much  enlarged  edition,  by  HENRY 
WATTS  and  ROBERT  BRIDGES,  M.  D.  Complete  in  one  large  and  handsome  octavo  volume, 
of  over  800  very  large  pages,  with  two  hundred  and  thirty-two  wood-cuts,  extra  cloth. 
$5  50. 

'Part  II.,  completing  the  work  from  p.  431  to  end,  with  Index,  Title  Matter,  <fcc.,  may  be  had 
separate,  cloth  backs  and  paper  sides.     Price  $3  00. 

From  Prof.  E.  N.  Horsford,  Harvard  College. 


It  has,  in  its  earlier  and  less  perfect  editions,  been 
•familiar  to  me,  and  the  excellence  of  its  plan  and 
the  clearness  and  completeness  of  its  discussions, 
iwive  long  been  my  admiration. 


afford  to  be  without  this  edition  of  Prof.  Graham's 
Elements. — Sitttman't  Journal,  March,  1S5S. 

From  Prof.  Wolcott  Gibbs,  N.  Y.  Free  Academy. 

The  work  is  an  admirable  one  in  all  respects,  ana 
its  republication  here  cannot  fail  to  exert  a  positive 


.Jio  reader  of  English  works  on  this  science  can    influence  upon  the  progress  of  science  in  this  country. 


II KN-RY  C.  LEA'S  PUBLICATIONS — ( < '/»»-», />•/;•>/.  I'/tarmary,  tr.).      1 1 


(GEORGE),  Ph.  I>. 
A    MANUAL  ol-'    KI. KM  i:\TAKV  ('Hi:. \IISTKY;    Theorotioal  and 

PraotioHl.    With  one  hundred  and  ninety-seven  illustration:".    Edited  by  ROBERT  BRIDORH, 
M    I).     In  one  large  royal  iL'mo.  volume,  of  600  pages,  extra  cloth,  $2  00;  leather,  $2  50. 

We  know  of  no  treatise  in  the  language  so  well  I      We  know  of  none  within  the  same  limits  which 
cn.lculat.-d  to  aid  the  -tndeni   h  familiar  '  has  higher  claims  to  our  confidence  asa  college  elass- 

with  the  nninerovs  facts  in  the  Intrinsic  -  •:.  both  for  accuracy  of  detail  and  *ci«uiiflc  ar- 

whirli  »-d  as  a  text-  ,  rangement. — Auyuita  Medical  Journal. 

fcook  :  l"»l  lectures.  *  *  *  *        We  know  of  no  text-book  on  chemistry  that  we 

The  l..  il.ai  has  issued  from     woui,j  sooner  recommend  to  the  student   than  tliU 

our  pr-- .-Am- ri'--in  U>  //>.//  J-irti-tl.  ,,f  i.rof.  Fownes'  work.— Montreal  Medical 

.rain   most  cheerfully  recommend   It  as  th- 

,„.        A  new  and  revised  edition  of  one  of  the  best  elemen- 

•hat  we  have  yet  examined. — III.  and 

I.il    M-,l   -ii,'l  fiitry.  Journal. 

A   flrst-rate   work   upon   a  first-rate  subject — St. 
Louit  Med.  and  Surg.  Journal. 

No    manual   of    Chemistry  which   we   have    met 
-.1  near  meeting  the  wants  of  the  beginner. — 
Wutem  Journal  u/  Mtdicine  and  Surgery. 


and  English  student — N.  Y.  Journal  of  Medical  and 
Collateral  Science. 

We  unhesitatingly  recommend  It  to  medical  •In- 
dent*.— If.  W.  Jfed.  and  Surg.  Journal. 

This  is  a  most  excellent  text-book  for  class  Instruc- 
tion in  chemistry,  whether  for  school*  or  colleger — 
Silliman't  Journal. 


ABET,  AND  ni.oXAM'?  HANDBOOK  OF  CHKM1S- 
TUV.  I,  Practical,  and  Technical  Inone 

rol  -  -xtra  cloth.  $t  60. 

GARDNER'S  MEDICAL  CHEMISTRY.  1  vol.  12mo., 
with  wood-cuts*  pp.  396,  extra  cloth,  $1  00. 


KNAPP'S  TECHNOLOGY  ;  or  Chemistry  Applied  to 
the  Arts,  and  to  Mannfactures.  With  American 
additions,  by  Prof.  WALTER  R.  JORHSOK.  In  two 
very  handsome  octavo  volumes,  with  600  wood 
engravings,  extra  cloth,  $6  00. 


Prnfejunr  of  Mattria  Medlca  in  the  Philadelphia  College  nf  Pharmacy. 

A  T II  !•:  A  T ISE  OX  PH  A  1 1 M  A  0  Y.     Designed  as  a  Text-Book  for  the 

Student,  and  M  a  Guide  for  the  Physician  and  Pharmaceutist.     With  many  Formulae  and 
nations.     Third  Edition,  greatly  improved.     In  one  handsome  octavo  volume,. of  850 
pages,  with  several  hundred  illustrations',  extra  cloth.     $5  00. 

The  immense  amount  of  practical  information  condensed  in  this  volume  may  be  estimated  from 
the  fact  that  the  Index  contains  about  4700  items.  Under  the  head  of  Acida  there  are  312  refer- 
ences; under  BmplMtiUffi,  36 ;  Extracts,  159;  Lozenges,  25;  Mixtures,  55;  Pills,  56;  Syrups, 
I'M  ;  Tinctures,  138;  Unguentum,  57,  Ac. 


We  have  examined  this  large  volume  with  a  good 
deal  of  care,  and  find  that  the  author  has  completely 
exhausted  the  imbjm  upon  which  he  treats  ;  a  more 
complete  work,  we  think,  It  would  be  impossible  to 
find.  To  the  student  of  pharmacy  the  work  is  indis- 
pensable; Indeed,  so  far  as  we  know,  U  I*  the  only  one 
of  its  kind  in  ^xi-t.-ur.-,  and  even  to  the  physician  or 
medical  student  who  can  spare  five  dollars  to  pur- 
chase it,  we  feel  sure  the  practical  information  he 
will  obtain  will  more  than  compensate  him  for  the 
outlay. — Caitada  M*l.  Jonrnnl,  NOT.  1864. 


not  been  clearly  and  carefully  discussed  in  this  vol- 
ume. Want  of  space  prevents  oar  enlarging  further 
on  this  valuable  work,  and  we  must  conclude  by  a 
Hituple  expression  of  our  hearty  appreciation  of  its 
merits. — DiMin  Quarterly  Jour,  of  Medical  Science, 
August,  1364. 

We  have  in  this  able  and  elaborate  work  a  fair  ex- 
position of  pharmaceutical  science  as  it  exists  in  the 
United  States  ;  and  it  shows  that  our  transatlantic 
friends  have  given  the  auhjeet  most  elaborate  con- 
sideration, and  have  brought  their  art  to  a  degree  of 


The  medical  student  and  the  practising  physician    perfection   which,  we  believe,  i»  scarcely  to  be  snr- 
III  find  the  volume  of  vr..itli  for  study     pa«M-<l  anywhere.     The  book  is,  of  course,  <.f  more 

•I  :f.  i-t  valiii-  to  the  in.-.l  .•:  n.-  m.tk><r  tli.iu  to  the  physi- 

1  to  introduce 
:x  as   much 


and   reference. — San  Francisco  Med.   Pmm,  July, 


When  w.-  say  that  this  book  is  In  some  t 
the  best  which  ha*  l»-cn  published  on  the  subject  in 
.  !Uh  language  for  a  great  many  years,  we  do 
not  wish  it  t  •  i>-  r.  !--r«tood  as  very  extravagant 
praise.  In  truth,  it  in  not  HO  much  the  best  M  the 
only  !• 

An  attempt  to  furnish  anything  like  an  an 
Parrish's  very  valuable  .« 
Pratt 

we  have  at  ••• 
much   a  miittiT  of  r.'i 
difficult  to  think  of  a 
•ly  trivial,  con 


clan;  yet  Mr.   I'AHHISH   h. 


matter  In   which   tin- 
interested  as  the  compou; 
cln-ion,  we  can  only  expre 


In 

<  our  huh  opinion  of  the 


value  of  this  work  as  a  guide  to  the  pharmaceutist, 


and  in  many 


to  the  |>hy»ician.  not  uiily  in 


,  but    in  other  part-  of  the  world.—  Britisk 
Mfd.  Journiil.  Xov.  l-'th,  18W. 


of  pharmaceutic  sub-taur 


The  fonii.T  ••.l:tion«    have  been  snfflclently  long 
i-;il  puMir  to  rem|er  tin-  merit*  of  the 
»  >rk  well  known.     It  is  certainly  one  of  t!..-   m  •••: 
i-  it   would  be    complete  and   .  practical  pi 

with  the  ma  i 

'!  •.  irh,    |S'    i. 


ProffSMir  nf  In.-.'  •  /«,  PhUadrl i 

GENERAL  THEEAPEUTICS  AND  M  \TKKIA  Mi:i»lf.\:  :i.l:i|.tf.i 

for  a  Medical  Text-Hook.      With  Iii'lrx.--  ol"  ll«Mii''. !!<••<  aii'l  nf  I>i--:i-i.-s  and  thi-ir  H.-in.'  li.'". 
Sixth  editinn,  re\  i.'ed  und  iinpm-,  .-.1.     \\  \:\\  one  tmiidred  .-ui'l  niii.-ty  thf-t-  illustratinr,-.     la 
two  large  and  h&ndaomelj  }>riiitt-<l  m'tavo  vols.  of  about  1  Hid  piige.s,  extra  cloth.     $6  50. 
Dr   THK   8.1. VK   AfTHuR 

XK\V    IIK.MKDIKS.   WITH     !•'(  >  II  M  I -  \..\-.    !  <>K   TIIKIK    I'll  K  PA  II  A- 

TION    AN!'  AI'.MINI-THATP'X.      S.-vmth   edition,   with  extensive  additions.     In  on* 
very  large  octavo  volume  of  770  pages,  extra  cloth.     $4  00. 


12       HENRY  C.  LEA'S  PUBLICATIONS — (Mat.  Med.  and  Therapeutics). 
VTILLE  (ALFRED),  M.D., 

A-3  Professor  of  Theory  and  Practice  of  Medicine  in  the  University  of  Penna. 

THERAPEUTICS  AXD  MATERIA  MEDICA;  a  Systematic  Treatise 

on  the  Action  and  Uses  of  Medicinal  Agents,   including  their  Description  and  History. 

Third  edition,  revised  and  enlarged.     In  two  large  and  handsome  octavo  volumes  of  about 

1700  pages,  extra  cloth,  $10  ;  leather,  $12.      (Now  Ready.) 

That  two  large  editions  of  a  work  of  such  magnitude  should  be  exhausted  in  a  few  years,  is 
sufficient  evidence  that  it  has  supplied  a  want  genernlly  felt  by  the  profession,  and  the  unani- 
mous commendation  bestowed  upon  it  by  the  medical  press,  abroad  as  well  as  at  home,  shows 
that  the  author  has  successfully  accomplished  his  object  in  presenting  to  the  profession  a  system- 
atic treatise  suited  to  the  wants  of  the  practising  physician,  and  unencumbered  with  details 
interesting  only  to  the  naturalist  or  the  dealer.  Notwithstanding  its  enlargement,  the  present 
edition  has  been  kept  at  the  former  very  moderate  price. 

From  the  Preface  to  the  Third  Edition. 

Although  the  second  edition  of  this  work  had  for  many  months  been  out  of  print,  the  author 
preferred  to  delay  a  new  issue  of  it,  rather  than  omit  anything  which  appeared  to  be  substantially 
valuable  among  the  recent  advances  of  the  science  and  art  of  Therapeutics.  The  subjects  now 
treated  of  for  the  first  time,  are  :  CHROMIC  ACID  ;  PERMANGANATE  OF  POTASSA  ;  THE  SULPHITES 
OP  SODA,  ETC.  ;  CARBOLIC  ACID;  NITROUS  OXIDE;  RHIGOLENB ;  and  CALABAR  BEAN.  The 
article  on  BROMINE  has  been  prepared  entirely  anew  ;  and  that  on  ELECTRICITY  very  materially 
enlarged  by  an  account  of  the  most  recent  improvements  in  electrical  apparatus,  and  in  the  appli- 
cation of  this  agent  to  the  cure  of  disease.  The  additions  which  have  been  mentioned,  with 
much  new_matter  besides,  which  will  be  found  under  the  more  important  titles,  occupy  nearly 
one  hundred  pages. 

April,  1868.  * 

A  few  notices  of  former  editions  are  subjoined. 

We  have  placed  first  on  the  list  Dr.  Stille's  great  ,  hardly  find  a  work  written  in  a  style  more  clear  and 
work  on  Therapeutics.  When  the  first  edition  of  this  simple,  conveying  forcibly  the  facts  taught,  and  yet 
work  made  its  appearance  nearly  five  years  ago,  we  j  free  from  turgidity  and  redundancy.  There  is  a  fas- 
expressed  our  high  sense  of  its  value  as  containing  a  j  cination  in  its  pages  that  will  insure  to  it  a  wide  po- 
full  and  philosophical  account  of  the  exiting  state  |  pularity  and  attentive  perusal,  and  a  degree  of  use- 
of  Therapeutics.  From  the  opinion  expressed  at  that  i  fulness  not  often  attained  through  the  influence  of  a 
time  we  have  nothing  to  retract;  we  have,  on  the  single  work.  The  author  lias  much  enhanced  the 
contrary,  to  state  that  the  introduction  of  numerous  practical  utility  of  his  book  by  passing  briefly  over 
additions  has  rendered  the  work  even  more  complete  '  the  physical,  botanical,  and  commercial  history  of 
than  formerly.  We  can  cordially  recommend  to  those  :  medicines,  and  directing  attention  chiefly  to  their 
of  our  readers  who  are  interested  in  Therapeutics  a  physiological  action,  and  their  application  for  the 
careful  perusal  of  Dr.  Still6's  work. — Edinburgh  Med.  amelioration  or  cure  of  disease. — Chicago  Med.  Jour- 


Journal,  1865. 

An  admirable  digest  of  our  present  knowledge  of 
Materia  Medica  and  Therapeutics. — Am.  Journ.  Med. 
Sciences,  July,  1860. 

Dr.  Stille's  splendid  work  on  therapeutics  and  ma- 


nal,  March,  IStiO. 

It  has  held  from  its  appearance  in  1860,  the  place 
it  so  well  deserves,  that  of  the  best  treatise  on  Thera- 
peutics in  the  English  language  A  considerable 
amount  of  new  matter  has  been  added  to  this  edition 


teria  medica.—  London  Med.  Times,  April  8,  1S65.        j  without  increasing  its  bulk,  and  its  general  appear- 


We  think  this  work  will  do  much  to  obviate  the 
reluctance  to  a  thorough  investigation  of  this  branch 
of  scientific  study,  for  In  the  whole  range  of  medical 
literature  treasured  in  the  English  tongue,  we  shall 


ance  is  all  that  could  be  desired  of  a  work  which 
should  find  a  place  in  the  hand  library  of  every  stu- 
dent and  physician. — Boston  Med.  and  Sara.  Jour- 
nal, Dec.  15,  1S04. 


riRIFFITH  (ROBERT  E.),  M.D. 

A  UNIVERSAL  FORMULARY,  Containing  the  Methods  of  Pre- 
paring and  Administering  Officinal  and  other  Medicines.  The  whole  adapted  to  Physicians 
and  Pharmaceutists.  Second  edition,  thoroughly  revised,  with  numerous  additions,  by 
ROBERT  P.  THOMAS,  M.D.,  Professor  of  Materia  Medica  in  the  Philadelphia  College  of 
Pharmacy.  In  one  large  and  handsome  octavo  volume  of  650  pages,  double-columns. 
Extra  cloth,  $4  00;  leather,  $5  00. 

In  this  volume,  the  Formulary  proper  occupies  over  400  double-column  pages,  and  contains 
about  5000  formulas,  among  which,  besides  those  strictly  medical,  will  be  found  numerous  valuable 
receipts  for  the  preparation  of  essences,  perfumes,  inks,  soaps,  varnishes,  Ac.  Ac.  In  addition  to 
this,  the  work  contains  a  vast  amount  of  information  indispensable  for  daily  reference  by  the  prac- 
tising physician  and  apothecary,  embracing  Tables  of  Weights  and  Measures,  Specific  Gravity, 
Temperature  for  Pharmaceutical  Operations,  Hydrometrical  Equivalents,  Specific  Gravities  of  some 
of  the  Preparations  of  the  Pharmacopeias,  Relation  between  different  Thermometrical  Scales, 
Explanation  of  Abbreviations  used  in  Formulas,  Vocabulary  of  Words  used  in  Prescriptions,  Ob- 
servations on  the  Management  of  the  Sick  Room,  Doses  of  Medicines,  Rules  for  the  Administration 
of  Medicines,  Management  of  Convalescence  and  Relapses,  Dietetic  Preparations  not  included  in 
the  Formulary,  List  of  Incompatible*,  Posological  Table,  Table  of  Pharmaceutical  Names  which 
differ  in  the  Pharmacopoeias,  Officinnl  Preparations  and  Directions,  and  Poisons. 

Three  complete  and  extended  Indexes  render  the  work  especially  adapted  for  immediate  consul- 
tation. One,  of  DISEASES  AND  THEIR  REMEDIES,  presents  under  the  head  of  each  disease  the 
remedial  agents  which  have  been  usefully  exhibited  in  it,  with  reference  to  the  formulas  containing 
them — while  another  of  PHARMACEUTICAL  and  BOTANICAL  NAMES,  and  a  very  thorough  GENERAL 
INDEX  afford  the  means  of  obtaining  at  once  any  information  desired.  The  Formulary  itself  is 
arranged  alphabetically,  under  the  heads  of  the  leading  constituents  of  the  prescriptions. 

We  know  of  none  in  our  language,  or  any  other,  so 


This  is  one  of  the  most  useful  books  for  the  prac- 
tisins  physician  which  has  been  issued  from  the  press 
of  late  yi;ars,  containing  a  vast  variety  of  formulas 
for  the  safe  and  convenient  administration  of  medi- 
cines, al1  arranged  upon  scientific  and  rational  prin- 
ciples, with  tlie  quantities  stated  in  full,  without 
signs  or  abbreviations. — Memphis  Med.  Recorder. 


comprehensive  in  its  details.— London.  Lancet. 

One  of  the  most  complete  works  of  the  kind  in  any 
language. — Edinburgh  Med.  Journal. 

We  are  not  cognizant  of  the  existence  of  a  parallel 
work. — London  Med.  Gazette. 


,    HENRY  C.  T.KA'S  Pi  ni.irATiONS — (Mat.  Med.and  Therapeutics).      13 

p  ERE  IRA  (JONATHAN),  M.D.,  F.R.S.  and  L.S. 

.MATKUIA     MKDICA    A  NI>   TIIF.K  A  PK.rTICS;    lu-in«r  :»n    A3 

ineiit  of  the  late  Hr.  Pereira's  Elements  of  M.iteria  Me.liea,  arranged  in  conformity  with 
the  British  PharmacopoMa,  nnd  ud.ij.ted  to  the  use  of  Medi-al  Practitioners,  Chemists  and 
KriU".M-t-.  Medical  and  Ph  inn:iceiiti-al  Student*,  Ac.  Hy  F.  J.  PAI;.  -enior 

Physi.-ian  to  Si.  Bartholomew's  Hospital,  and  London  Editor  of  the  British  Pharmacopoeia; 

:KRT  BKKTI.KI  .  M.K.r  S  .  IV. .s r  of  Materia  Medica  and   Botany  to  the 

Pharmaceutic.i:  •    iireat  Britain:   and  hy  K»IU:I:T  U  MMM.I.  v  F.R. 8.,  Chemical 

Operator  to  the  Society  of  A|>otli irie.«.      With  numerous  additions  and  references  to  the 

United  States  Pharmacopoeia,  hy  HORATIO  C.  Woor>.  M.D.,  Professor  of  Botany  in  the 
University  of  Pennsylvania.  In  one  large  and  h  indsome  octavo  volume  of  1040  closely 
printed  pages,  with  236  illustrations,  extra  cloth,  $7  00;  leather,  raised  bands,  $8  04. 
(Just  Issued.) 

The  task  of  the  American  editor  has  evidently  been 
no  sinecure,  fur  not  only  has  he  given  to  us  all  that 
is  contained  ill  th-  ,  r  pur-  I 

pose*,  but  by  a  careful  an  > 

over  a  hundred  new  remedies  has  increased  Ub&ldMl 
of  the  former  work  fully  one-third,  l.e-i.le-  adding 
many  new  illustrnt  >  are  original    ' 

We  in:  -  ty  that  by  so  doing  he  has  pro-  i 

portionateiy  .lyof  the  con-  | 

.  but  lis»  exvn.l.-d  the  applicability  of 
...t  original,  and  has  placed  his  medical  coun- 
trymen un.l'  r  lasting  obligations  to  him.     The  Ame- 
in   now  has  all   that  is   needed   in  the 
shape  •  tr-ali>e  on  materia  medica,  and 

the  medical  student  li»*;t  text-book  which,  for  prac- 
tical utility  and  intrin-ic  worth,  stands  unparalleled. 
Although  of  considerable  *ij.e,  it  is  none  too  large  for 
the  purposes  for  which  It  has  been  intended, and  every 
medical  man  should,  in  justice  to  himself,  spare  a 
place  for  it  upon  his  book-shelf,  resting  assured  that 
the  more  he  consult-  it  the  better  he  will  be  satisfied 
of  Us  excellence.— \  Y.  M-d.  K.< ••./••/,  X..v.  is,  1886. 

It  will  fill  a  place  which  no  other  work  can  occupy 
in  the  library  of  the  physician,  student,  and  apothe- 
cary.— B»st»n  Med.and  Surg.  Journal,  Nov.  8,  1S66. 

Of  the  many  works  on  Materia  Medica  which  have 
appeared  since  the  issuing  of  the  British  Pharmaco- 


prela,  none  will  be  more  acceptable  to  the  ntndent 
and  practitioner  than  the  present.  Pereira's  Materia 
><ad  long  ago  asserted  for  itself  t!. 

••!ete  work  on  the  subject  in  tba 
English  language.  But  its  very  completeness  stood 
In  the  way  of  Us  success.  Except  in  the  way  of  refer- 

•  made  a  special  study  of  Materia 
Medica,  Dr.  1'eroira's  work  was  too  full,  and  its  pe- 
luired  an  amount  of  time  which  few  had  at 
-poxal.  Dr.  Karre  has  very  Judiciously  availed 
him-elt'of  the  cvj.portunity  of  the  publication  of  the 
new  Pharinacopceia.  by  bringing  out  an  abridged  edi- 
tion of  the  great  work.  This  edition  of  Pereira  is  by 
no  means  a  mere  abridged  re-issue,  but  contain*  ma- 
ny improvements,  both  in  the  descriptive  and  thera- 
peutical departments.  We  can  recommend  it  as  a 
very  excellent  and  reliable  text-book.— Edint/urgh 
Jfed  Journal,  February,  1S66. 

The  reader  cannot  fail  to  be  <mpre«s«d,  at  a  glance, 
with  the  exceeding  value  of  this  work  as  a  C" 
of  nearly  all  useful  knowledge  on  the  materia  medica. 
We  are  greatly  indebted  to  Profe«sor  Wood  for  his 
adaptation  of  it  to  our  meridian.  Without  his  emen- 
dations and  additions  it  wonld  love  much  of  its  value 
to  the  American  stndent.  With  them  it  is  an  Ameri- 
can book.—  P'fijic  Medical-  and  Surgical  Journal, 
December,  1866. 


>'  (BENJAUIX),  M.D. 
'Till:  MKniPAL  FORMULARY:  being  a  Collection  of  Prescriptions 

derived  from  the  writings  and  practice  of  mnny  of  the  most  eminent  physicians  of  America 
and  Europe.  Together  with  the  usual  Dietetic  Preparations  nnd  Antidotes  for  Poisons.  The 
whole  accompanied  with  a  few  brief  Pharmoceutic  and  Medical  Observations.  Twelfth  edi- 
tion, carefully  revised  and  much  improved  by  ALBERT  H.  SMITH,  M.D.  In  one  volume  8vo. 
of  :t7o  |MgM,  extra  cloth,  $3  00.  (Now  Ready.) 

frequently  noticed  in  this  Journal  as  the  successive 
editions  appeared,  that  it  in  Mitlcient,  on  the  present 
occasion,  to  state  that  the  editor  has  introduced  into 
the  eleventh  edition  a  large  amount  of  new  matter, 
derived  from  the  current  medical  and  pharma. 
works  »«  well  MS  a  number  of  valuable  prescriptions 
furnished  from  private  sources.  A  very  comprehen- 
sive and  extremely  useful  Index  has  also  been  «np- 


We  endorse  the  favorable  opinion  which  the  book 

haa  so  long  e*tabli»hed  for  itself,  and  take  this  occa- 

••niiiiiiend  it  to  onr  readers  as  one  of  the  con- 

v.-ni.-nl  handbooks  of  the  office  and  library. — Ciu- 

cinmiti  Lnncet,  Feb.  1861. 

The  work  has  long  been  before  the  profession,  and 
its  merits  are  well  known.     The  |T.'-.-iit  ••il'.tion  con- 


tainsmany  valuable  additions,  and  will  bfltoundlo       „,.,,_   wll|c|l   fM.mut,>!(  r,.f,,r,,n(.p  to  the  p8rticni;ir 
h,.»n  exceedingly  convenient  ,  nine  tor    nr,ir,H  ,h(.  ,)r^M.ri|,..r  ,,1;lv  wiOl  to  a.lmiuUter  ;  and 

»l    practitioner.  -CWeofifO    tl,«  language  of  the  Korn.ulary  has  been  made  to  cor- 
i  wiib  the  iioi,,,-n.-!.,tur.'  of  the  new  national 
The  work  is  now  so  well  known,  and  has  tieen  KO    Pharmacopoeia.  —  Am  Sour.  Mai.  ScUnctt,  Jan 


M.D.. 

'  :'<nnnry  in  !'  •.  *C. 

SYNOPSIS  OF  .THE   rnrusi-:   OK    LECTURES   «»N    MATKKIA 

Mi:i>l«'A     \NI>   IMl  MIM  M'V.   delixered  in  the  Tnivervity  of  IVnnsylvanin.      With   throe 

i'-diciiu-.s.     Fourth  and  revised  edition,  extra  clolh, 
$3  00.     (Now  R«aJy.) 


ROTLE'S    MATKKIA    MKMU'A     AND    THK.i:  Al'KI'- 


Tll 


'    • 


'i     ninety-elf 

v.ilume  of  about  7cti 
pages,  extra  cloth,      i 
CHRIS 


CAK1'!   '  .'V    T!Ii:    • 

exp!: 


VolllIT 


large 
M   " 

Hi  > 


jth.     *i 


\  THE  THREE  KINMt<": 

.il    and  Th.  r;ip.Mi: 

nnula 

lined    in   tii.'    • 

•iiul.v  of  t(,e 
r.  -•    i'i  ir  -  :  :>.     la 

on-  IJn;.'    \  ..iiiiu- 


14 


HENRY  C.  LEA'S  PUBLICATIONS — (Pathology}. 


(7 ROSS  (SAMUEL  D.),  M.  D., 

Professor  of  Surgery  in  the  Jefferson  Medical  College  of  Philadelphia. 

ELEMENTS    OF    PATHOLOGICAL   ANATOMY.     Third    edition, 

thoroughly  revised  and  greatly  improved.  In  one  large  and  very  handsome  octavo  volume 
of  nearly  800  pages,  with  about  three  hundred  and  fifty  beautiful  illustrations,  of  which  a 
large  number  are  from  original  drawings  ;  extra  cloth.  $4  00. 

The  very  beautiful  execution  of  this  valuable  work,  and  the  exceedingly  low  price  at  which  it 
is  offered,  should  command  for  it  a  place  in  the  library  of  every  practitioner. 

the  book-shelf  of  every  American  physician. — Charles- 


To  the  student  of  medicine  we  would  say  that  we 
know  of  no  work  which  we  can  more  heartily  com- 
mend than  Gross's  Pathological  Anatomy. — Southern 
Med.  and  Surg.  Journal. 

The  volume  commends  itself  to  the  medical  student ; 
It  will  repay  a  careful  perusal,  and  should  be  upon 


ton  Med.  Journal. 

It  contains  much  new  matter,  and  brings  down  our 
knowledge  of  pathology  to  the  latest  period. — London 
Lancet. 


JONES  (C.  HANDFIELD],  F.R.S.,  and  SIEVEKING  (ED..H.),  M.D., 


U 


Assistant  Physicians  and  Lecturers  in  St.  Mary's  Hospital. 

A  MANUAL  OF   PATHOLOGICAL  ANATOMY.     First  American 

edition,  revised.     With  three  hundred  and  ninety-seven  handsome  wood  engravings.     In 
one  large  and  beautifully  printed  octavo  volume  of  nearly  750  pages,  extra  cloth,  $3  50. 


Our  limited  space  alone  restrains  us  from  noticing 
more  at  length  the  various  subjects  treated  of  in 
this  interesting  work ;  presenting,  as  it  does,  an  excel- 
lent summary  of  the  existing  state  of  knowledge  in 
relation  to  pathological  anatomy,  we  cannot  too 
strongly  urge  upon  the  student  the  necessity  of  a  tho- 
rough acquaintance  with  its  contents. — Medical  Ex- 
aminer. 

We  have  long  had  need  of  a  hand-book  of  patholo- 
gical anatomy  which  should  thoroughly  reflect  the 
present  state  of  that  science.  In  the  treatise  before 
us  this  desideratum  is  supplied.  Within  the  limits  of 
a  moderate  octavo,  we  have  the  outlines  of  this  great 
department  of  medical  science  accurately  denned, 


and  the  most  recent  investigations  presented  in  suffi- 
cient detail  for  the  student  of  pathology.  We  cannot 
at  this  time  undertake  a  formal  analysis  of  this  trea- 
tise, as  it  would  involve  a  separate  and  lengthy 
consideration  of  nearly  every  subject  discussed  ;  nor 
would  such  analysis  be  advantageous  to  the  medical 
reader.  The  work  is  of  such  a  character  that  every 
physician  ought  to  obtain  it,  both  for  reference  and 
study. — N.  Y.  Journal  of  Medicine. 

Its  importance  to  the  physician  cannot  be  too  highly 
estimated,  and  we  would  recommend  our  readers  to 
add  it  to  their  library  as  soon  as  they  conveniently 
can. — Montreal  Med.  Chronicle. 


ftOKITANSKY  (CARL],  M.D., 

Curator  of  the  Imperial  Pathological  Mttseum,  and  Professor  at  the  University  of  Vienna. 

A   MANUAL   OF   PATHOLOGICAL   ANATOMY.      Translated  by 

W.  E.  STVAINE,  EDWARD  SIEVEKING,  C.  H.  MOORE,  and  G.  E.  DAY.    Four  volumes  octavo, 
bound  in  two,  of  about  1200  pages,  extra  cloth.     $7  50. 


GLUGE'S  ATLAS  OF  PATHOLOGICAL  HISTOLOGY. 
Translated,  with  Notes  and  Additions,  by  JOSEPH 
LEIDT,  M.  D.  In  one  volume,  very  large  imperial 
quarto,  with  320  copper-plate  figures,  plain  and 
colored,  extra  cloth.  ij>±  00. 


SIMON'S  GENERAL  PATHOLOGY,  as  conducive  to 
the  Establishment  of  Rational  Principles  for  the 
Prevention  and  Cure  of  Disease.  In  one  octavo 
volume  of  212  pages,  extra  cloth.  $1  2.3. 


TyiLLIAMS  (CHARLES  J.  B.},  M.D., 

Professor  of  Clinical  Medicine  in  University  College,  London. 

PPvINCIPLES  OF  MEDICINE.     An  Elementary  View  of  the  Causes, 

Nature,  Treatment,  Diagnosis,  and  Prognosis  of  Disease;  with  brief  remarks  on  Hygienics, 
or  the  preservation  of  health.  A  new  American,  from  the  third  and  revised  London  edition. 
In  one  octavo  volume  of  about  500  pages,  extra  cloth.  $3  50. 

The  unequivocal  favor  with  which  this  work  has  |      A  text-book  to  which  no  other  in  our  language  is 

comparable. — Charleston  Med.  Journal. 
The  lengthened  analysis  we  have  given  of  Dr.  Wil- 


been  received  by  the  profession,  both  in  Europe  and 
America,  is  one  among  the  many  gratifying.evidences 


which  might  be  adduced  as  going  to  snow  that  there 
is  LI  steady  progress  taking  place  in  the  science  as  well 
as  in  the  art  of  medicine. — St.  Louis  Mad.  and  Surg. 
Journal. 

No  work  has  ever  achieved  or  maintained  a  more 
deserved'  reputation. —  Virginia  Med.  and  Surg. 
Journal. 

One  of  the  best  works  on  the  subject  of  which  it 
treats  in  our  language. 

It  has  already  commended  itself  to  the  high  regard 
of  the  profession  ;  and  we  may  well  say  that  we 
know  of  no  single  volume  that  will  afford  the  source 
of  so  thorough  a  drilling  in  the  principles  of  practice 


liams's  Principles  of  Medicine  will,  we  trust,  clearly 
prove  to  our  readers  his  perfect  competency  for  the 
task  he  has  undertaken — that  of  imparting  to  the 
student,  as  well  as  to  the  more  experienced  practi- 
tioner, a  knowledge  of  those  general  principles  of 
pathology  on  which  alone  a  correct  practice  can  be 
founded.  The  absolute  necessity  of  such  a  work 
must  be  evident  to  all  who  pretend  to  more  than 
mere  empiricism.  We  must  conclude  by  again  ex- 
pressing our  high  sense  of  the  immense  benefit  which 
Dr.  Williams  has  conferred  on  medicine  by  the  pub- 
lication of  this  work.  We  are  certain  that  in  the 
present  state  of  our  knowledge  his  Principles  of  Medi- 
cine could  not  possibly  be  surpassed.  While  we 


as   this.     Students  and   practitioners  should  make  j  regret  the  loss  which  many  of  the  rising  generation 
themselves  ^intimately  familiar^  witl^its  teachings—    of  praetitioners  have  sustained  by  his  resignation  of 

the  Chair  at  University  College,  it  is  comforting  to 


they  will   find  their  labor  and  study  most  amply 


repaid. — Cincinnati  Med.  Observer. 

There  is  no  work  in  medical  literature  which  can 
fill  the  place  of  this  one.  It  is  the  Primer  of  the 
young  practitioner,  the  Koran  of  the  scientific  one. — 
Stethoscope. 


feel  that  his  writings  must  long  continue  to  exert  a 
powerful  influence  on  the  practice  of  that  profession 
for  the  improvement  of  which  he  has  so  assiduously 
and  successfully  labored,  and  in  which  he  holds  so 
distinguished  a  position. — London  Jour,  of  Medicine 


HK.NKY  C.  LEA'S  PUBLICATIONS — (Practice  of  Medicine). 


15 


J^L/XT  (AUSTIN),  .!/-/>.. 

'  Pm/eMor  •/  ,".-  /Vi«.-i>fe«  and  Practice  of  Medicine  in  BcUrvue  Med.  Colltge,  A   ) 

A    TKKATISK    ON     TI1K     I'KI  N<M  IM.FS     A  \  I »     I'liM'TICE    OF 

MKI'ICINK:  de-ij.'m-d  fur  \\\v  \\«v  of  Stinlenta  and  Practitioners  of  Medicine.  Third 
e<liti<>n,  r.-\i-e.l  Mint  enlarge. I.  In  one  large  and  closely  printed  octavo  volume  of  1002 
pages :  liamlsome  extra  cloth,  $6  00 ;  or  strongly  bound  in  leather,  with  raised  bands,  $7  00. 
(Jint  lit. nly.) 

t/if  Prr fur*  to  tlif  Tliirti  Kililinn. 

Since  the  puMi'-ation,  in  December,  1860,  of  the  second  edition  of  this  treatise,  tnneh  time  has 
been  devoted  to  its  re\ision.  It. •< ••  trui/ing  in  the  favor  with  which  it  has  been  received  a  pro- 
portionate obligation  to  .strive  constantly  to  inert-use  it.«  worthiness,  the  author  has  introduced  in 
the  present  edition  additions,  derived  from  his  clinical  studies,  and  from  the  latest  contributions 
in  medical  literature,  wlii.-h.  it  is  tx-lieved,  will  enhance  considerably  the  practical  utility  of  the 
work.  A  slight  modification  in  the  typographical  arrangement  has  accommodated  these  additions 
without  materially  increasing  the  bulk  of  the  volume. 

NEW  YOKK,  October,  1868. 

At  the  very  low  price  nffixed,  the  profession  will  find  this  to  be  one  of  the  cheapest  volumes 
within  their  reach.  A  few  notices  of  former  editions  are  subjoined. 


We  are  happy  in  being  able  once  more  to  commend 
thin  work  to  t hi-  si udents  and  practitioners  of  im-.hr  ne 
who  seek  fur  accurate  Information  conveyed  in  lan- 
guage at  once  clear,  precise,  and  expressive. — Amer. 

.-•es,  April,  1867. 

Dr.  Flint,  who  ban  been  known  in  this  country  for 
many  years,  both  as  an  author  and  teacher,  who  lias 
discovered  truth,  and  pointed  it  out  clearly  and  dis- 
tinctly to  other*,  investigated  the  symptoms  and  na- 
tural history  of  disease  aud  recorded  it-  language  and 
facts,  and  devoted  a  life  of  incestiant  study  and 
thought  to  the  doubtful  or  obscure  in  bis  profession, 
has  at  length,  in  his  ripe  scholarship,  given  this  work 
to  the  profession  an  a  crowning  gift.  I  f  w'e  have  spoken 
highly  of  its  value  to  the  proleiuiion  and  world  ;  if  we 
have  said,  all  considered,  it  is  the  very  best  work 
upon  medical  practice  in  any  language;  if  we  have 
spoken  of  its  excellences  in  detail,  and  given  points 
of  special  value,  we  hnve  yet  failed  to  express  in  any 
degree  our  iir.--.-nt  ••-innate  of  its  value  as  a  guide  in 
the  practice  of  medicine.  It  does  not  contain  toomnch 
or  too  .  'iibt  should  be 

T,.  where  truth  is  known.     It  is 
*ud  --peculative  where  philosophy  and 
•peculation  are  all  tli.-.t  can  at  pr.----nt  !»•  obtained, 
-  admitted  to  th«  elevation  ut  established 
truth,  without  the  ino-t  thorough  investigation.     It 
remarkable  with  what  evt-n  lmtnl  this  work 
',  written,  and  how  it  all  shows  the  mostcare- 
fnl  thought  and   uniirinit  Ktndy.     We  conclude  that, 
th-Mich  it  may  yet  be  susceptible  of  improvement,  it 
Mill  con-titu ted  the  very  bunt  which  human  knowledge 
can  at  present  |>r«<lnre.      "When  knowledge  is  in- 
"  the  work  will  doubtless  be  again  revised; 
meanwhile  we  nhn!1  -  ;!)•>  rule  of  practice. 

—  Htifulo  Med.  and  Surg.  Journal,  Feb.  l-«;7. 

Dr.  Flint's  book  is  the  only  one  on  the  practice  of 
medicine  that  c;in  benefit  the  young  practitioner. — 
•     /.  Journal,  Aug.  18rt6. 

W-  eoai  .i.-r  the  1 k,  in  all  it»  essentials,  as  the 

hem  S(l»|>t.-'t  to  the  -.indent  of  any  of  our  num>-n»i- 
•  kii  on  this  subject.— .V.  1'  Med.  Journ.,  Jan.'67. 


It«  terse  conciseness  fully  redeem*  It  from  being 
ranked  among  heavy  and  common-place  works,  while 
the  unmistakable  way  in  which  Dr.  Flint  give*  kit 
own  views  is  quite  refreshing,  and  far  from  common. 
It  is  a  book  of  enormous  research  ;  the  writer  is  evi- 
dently a  man  of  observation  and  large  experience; 
his  views  are  practically  sound  and  theoretically 
moderate,  and  we  have  no  hesitation  In  commending 
his  magnum  opus  to  our  readers. — Dublin  Medical 
Press  and  Circular,  May  16,  1866. 

In  the  plan  of  the  work  and  the  treatment  of  indi- 
vidual subjects  there  is  a  fresh  ness  and  an  originality 
which  make  it  worthy  of  the  study  of  practitioners 
as  well  as  students.  Ills,  indeed,  an  admirable  book, 
and  highly  creditable  to  American  medicine.  For 
clearness  and  conciseness  in  style,  for  careful  reason- 
ing upon  what  is  known,  for  lucid  distinction  between 
what  we  know  and  what  we  do  not  know,  between 
what  nature  does  in  disease  and  what  the  physician 
can  do  and  should,  for  richness  in  good  clinical  ob- 
servation, for  independence  of  statement  and  opinion 
on  great  points  of  practice,  and  for  general  sagacity 
and  good  Judgment,  the  work  is  mo-t  meritorious. 
It  is  singularly  rich  in  good  qualities,  and  free  from 
faults. — London  Lancet,  June  23,  1S66. 

In  following  out  such  a  plan  Dr.  Flint  has  snc- 
ceeded  most  admirably,  and  gives  to  his  readers  a 
work  that  is  not  only  very  readable,  interesting, 
and  concise,  but  in  every  respect  calculated  to  meet 
the  requirements  of  professional  men  of  every  class. 
The  student  has  presented  to  him,  in  the  plainest 
possible  manner,  the  symptoms  of  disease,  the  prin- 
ciples  which  should  guide  him  In  its  treatment,  and 
the  difficulties  which  have  to  be  surmounted  in  order 
to  arrive  at  a  correct  diagnosis.  The  practitioner, 
besides  baring  such  aids,  has  offered  to  him  the  con- 
clusion which  the  experience  of  the  professor  has 
enabled  him  to  arrive  at  in  reference  to  the  relative 
merits  of  different  therapeutical  agents,  and  different 
methods  of  treatment.  This  new  work  will  add  not 
a  little  to  the  well-earned  reputation  of  Prof.  Flint  as 
a  medical  teacher.— .y.  Y.  Mad.  Record,  April  2,  1866. 


nr.NY7/,/>v).v.  FO  A-  /;/•>•.  yir/-:  /•;/>//•:.  A\n 

THE  CYCLOIMCIHA    OF    I'UACTICAL   MKPK'INF.:    ooini.ri-iii.r 

Treatises  on   the  Nature  ami  Treatment   of  '!  it'-ria   Medicn  and   Therapeutics, 

\\  '..in.  n  ami  Children,  Me.lical  Jurisprudence,  Ao.  Ac.     In  four  large  super-royal 
.1  volumes.  ni.'l-.'M  ili.uljle-coluiuued  pages,  strongly  and  handsomely  bound  in  leather, 
$15  ;  extra  cloth,  $11. 

*»*  This  work  contain*  no  les*  than  four  hundred  and  eighteen  distinct  treatises,  contributed 
by  sixty-eight  distinguished  physicians. 


The   most    complete   work   on    practical    medicine 
extant,  or  at  least  iu  our  language.  —  Buffalo  Medical 

<ry  it  nl  Jnti. 

F.T  reference,  It  is  above  all  price  to  every  practi- 
tioner. —  \\'nttrrn  I, 
One  of  the  most  valuable  medical  publications  of 


the  day.     As  a  work  of  reference  It  Is  Invaluable.  — 
Western  Journal  of   '  .-/  Surgery. 

It  has  been  to  us,  both  as  learner  and  teacher,  a 
work  for  ready  and  frequent  reference,  one  in  which 
ni'>d.Tii  Kni(M-h  medicine  is  .-xhihit,  d  in  the  most  ad- 
vantageous light.  —  Mfdirn: 


BAKI.<n\"<  MA.V.U.  up  TIIK  PRATT 
XKDirlNK.  With  Addition-  l>y  I)  F.  < 
M.I).  1  vol.  SA-O.,  pp.  000,  cloth.'  ;. 


H"U,AXIi-S     MKDICAT,     N"TK.s     AND     K 

From  tliM  third  and  enlarged   Eugl;- 
tion.     In   one    hand-oui.  .uie  of  about 

500  pages,  extra  cloth.    |3  5U. 


16 


HENRY  C.  LEA'S  PUBLICATIONS — (Practice  of  Medicine}. 


TTARTSHORNE  (HENRY],  M.D., 

-*-  -*•  Professor  of  Hygiene  in  the  University  of  Pennsylvania. 

ESSENTIALS  OF  THE  PRINCIPLES  AND   PRACTICE  OF  MEDI- 

CINE.     A  handy-book  for  Students  and  Practitioners.     In  one  handsome  royal  12mo. 

volume  of  418  pages,  clearly  printed  on  small  type,  cloth,  $2  38;    half  bound,  $2  63. 

(Jnst  Issued.) 

The  very  cordial  reception  with  which  this  work  has  met  shows  that  the  author  has  fully  suc- 
ceeded in  his  attempt  to  condense  within  a  convenient  compass  the  essential  points  of  scientific 
and  practical  medicine,  so  as  to  meet  the  wants  not  only  of  the  student,  but  also  of  the  practi- 
tioner who  desires  to  acquaint  himself  with  the  results  of  recent  advances  in  medical  science. 

As  a  strikingly  terse,  full,  and  comprehensive  em-  |  nearly  than  any  similar  manual  lately  before  us  the 
bodiment  in  a  condensed  form  of  the  essentials  in  ,  standard  at  which  all  such  hooks  should  aim  —  of 
medical  science  and  art,  we  hazard  nothing  in  saying  •  teaching  much,  and  suggesting  more.  To  the  student 
that  it  is  incomparably  in  advance  of  any  work  of  the  we  can  heartily  recommend  ihe  work  of  our  transat- 
kind  of  the  past,  and  will  stand  long  in  the  future  i  lantic  colleague,-  and  the  busy  practitioner,  we  are 
without  a  rival.  A  mere  glance  will,  we  think,  iin-  I  sure,  will  find  in  it  the  means  of  solving  many  a 


press  others  with  the  correctness  of  our  estimate.  Nor 
do  we  believe  there  will  be  found  many  who,  after 
the  most  cursory  examination,  will  fail  to  possess  it. 
How  one  could  be  able  to  crowd  so  much  that  is  valu- 
able, especially  to  the  student  and  young  practitioner-, 


doubt,  and  will  rise  from  the  perusal  of  its  pages, 
having  gained  clearer  views  to  guide  him  in  his  daily 
struggle  with  disease.— Z>M&.  Mtd.  Press,  Oct.  2,  1807. 
Pocket  handbooks  of  medicine  are  not  desirable, 
even  when  they  are  as  carefully  and  elaborately  com- 


withiu  the  limits  of  so  small  a  book,  and  yet  embrace  ]  piled  as  thig)  tne  iatest>  most  compie,e,  and  most 


and  present  all  that  is  important  in  a  well-arranged, 
clear  form,  convenient,  satisfactory  for  reference,  with 
so  full  a  table  of  contents,  and  extended  general  index, 
with  nearly  three  hundred  formulas  and  recipes,  is  a 
marvel. —  Western  Journal  of  Medicine,  Aug.  1807. 

The  little  book  before  us  has  this  quality,  and  we 
can  therefore  say  that  all  students  will  find  it  an  in- 
valuable guide  in  their  pursuit  of  clinical  medicine. 
Dr.  Hartshorne  speaksofitas  "an  unambitious  effort 
to  make  useful  the  experience  of  twenty  years  of  pri- 
vate and  hospital  medical  practice,  with  its  attendant 
study  and  reflection."  That  the  effort  will  prove  suc- 


curate  which  we  'have  seen. — British  Mtd.  Journal, 
Sept.  21,  1S67. 

This  work  of  Dr.  Hartshorne  must  not  be  confound- 
ed with  the  medical  manuals  so  generally  to  be  found 
in  the  hands  of  students,  serving  them  at  best  but  us 
blind  guides,  better  adapted  to  lead  them  astray  than 
to  any  useful  and  reliable  knowledge.  The  work  be- 
fore us  presents  a  careful  synopsis  of  the  essential 
elements  of  the  theory  of  diseased  action,  its  causes, 
phenomenac  and  results,  and  of  the  art  of  healing,  as 
recognized  by  the  most  authoritative  of  our  prufi->- 
sional  writers  and  teachers.  A  very  careful  and  can- 


cessful  we  have  no  doubt,  and  in  his  study,  and  at  j  did  examination  of  the  volume  has  convinced  us  that 
the  bedside,  the  student  will  find  Dr  Hartshorne  a  j  it  will  be  generally  recognized  as  one  of  the  best  man- 
safe  and  accomplished  companion.  We  speak  thus  I  nalsfor  the  use  of  the  student  that  ha-  yei  appeared. 
highly  of  the  volume,  because  it  approaches  more  I  —  American  Journal  Med.  Sciences,  Oct.  Ibti7. 


(THOMAS],  M.  D.,  &c. 
LECTURES  ON  THE  PRINCIPLES  AND  PRACTICE  OF 

PHYSIC.  Delivered  at  King's  College,  London.  A  new  American,  from  the  last  revised 
and  enlarged  English  edition,  with  Additions,  by  D.  FRANCIS  CONDIE,  M.  D.,  author  of 
"A  Practical  Treatise  on  the  Diseases  of  Children."  Ac.  With  one  hundred  and  eighty- 
five  illustrations  on  wood.  In  one  very  large  and  handsome  volume,  imperial  octavo,  of 
over  1200  closely  printed  pages  in  small  type;  extra  cloth,  $6  50;  strongly  bound  in 
leather,  with  raised  bands,  $7  50. 

Believing  this  to  be  a  work  which  should  lie  on  the  table  of  every  physician,  and  be  in  the  hands 
of  every  student,  every  effort  has  been  made  to  condense  the  vast  amount  of  matter  which  it  con- 
tains within  a  convenient  compass,  and  at  a  very  reasonable  price,  to  place  it  within  reach  of  all. 
In  its  present  enlarged  form,  the  work  contains  the  matter  of  at  least  three  ordinary  octavos, 
rendering  it  one  of  the  cheapest  works  now  offered  to  the  American  profession,  while  its  mechani- 
cal execution  makes  it  an  exceedingly  attractive  volume. 


DICKSON'S  ELEMENTS  OF  MEDICINE;  a  Compen- 
dious View  of  Pathology  and  Therapeutics,  or  the 
History  and  Treatment  of  Diseases.  Second  edi- 
tion, revised.  1  vol.  Svo.  of  750  pages,  extra  cloth. 
.$t  oo. 

WH  ATTO  OBSERVE  AT  THE  BEDSIDE  AND  AFTER 
DEATH  IN  MEDICAL  CASES.  Published  under  the 
authority  of  the  London  Society  for  Aledical  Obser- 


vation.    From  the  second  London  edition.     1  vol. 
royal  12mo.,  extra  cloth.     $1  00. 

LAYCOCK'S  LECTURES  ON  THE  PRINCIPLES 
AND  METHODS  OP  MEDICAL  OBSERVATION  AND  RE- 
SEARCH. For  the  use  of  advanced  students  and 
junior  practitioners.  In  one  very  neat  royal  12m  u. 
volume,  extra  cloth.  $1  00. 


J^ARCLAY  (A.  W.},  M.  D. 

A  MANUAL  OF  MEDICAL  DIAGNOSIS;  being  an  Analysis  of  the 

Signs  and  Symptoms  of  Disease.     Third  American  from  the  second  and  revised  London 
edition.     In  one  neat  octavo  volume  of  451  pages,  extra  cloth.     *3  50. 

A  work   of  immense   practical    utility. — London  I      The  book  should  be  in  the  hands  of  every  practical 
Med.  Times  and  Gazette.  \  man. — Dublin  Med.  Press. 


PULLER  (HEXRT  WILLIAM],  M.  D., 

-*-  Physician  to  St.  George's  Hvtpital,  London. 

ON  DISEASES  OF  THE    LUNGS   AND   AIR-PASSAGES.     Their 

Pathology,  Physical  Diagnosis,  Symptoms,  arrl  Treatment.  From  the  second  and  revised 
English  edition.  In  one  handsome  octavo  volume  of  about  500  pages,  extra  cloth,  $3  50. 
(Just  Issued.) 

Dr.  Fuller's  work  on  diseases  of  the  chest  was  so  ,  accordingly  we  have  what  might  be  with  perfect  jus- 
favorably  received,  that  to  many  who  did  not  know  i  tice  styled  an  entirely  uew  work  from  his  pen,  the 
the  extent  of  his  engagements,  it  was-a  matter  of  won-  portion  of  the  work  treating  of  the  heart  and  great 
der  that  it  should  be  allowed  to  remain  three  years  j  vessels  being  excluded.  Nevertheless,  this  volume  is 
out  of  print.  Determined,  however,  to  improve  it,  of  almost  equal  size  with  the  tirst. — Luiidun  JJedical 
Dr.  Fuller  would  not  consent  to  a  mere  reprint,  and  Times  and  Gazette,  July  20,  Ibo7. 


HENRY  C.  LEA'S  PUBLICATIONS— (Practice  of  Medicine). 


17 


Mrs77.v«.  .»/./>.. 

Pr»fet*or  of  the  Principle  ami  P.--i--!iif.  of  Medicine  In  Bellev**  Hospital  Med.  Cullffft,  .V.    T. 

PRACTICAL    TKKATISK    ON    TIM-:    PHYSICAL    KXPI.oKA- 

Tl"\  OF  T1IK  CHKST  AND  TI1K  DIAGNOSIS  OP  DISEASES  AFKK-  TIM}  THE 
BB8PIRATORY  ORGANS.  Second  and  revised  edition.  In  one  handsome  octavo  volume 
of  595  pages,  extra  cloth,  $4  50.  (Just  Issued.) 


Premising  this 
md  prac 


1S87. 


rach 
nted 


••     Ih    il 111*  i)f    III.- 

i  which  IIP  ran  commit.     The 


mericsn  medlein«.  —  Atlanta  Jftd.  and  Burg.  Jwtr- 
nnl,  Feb.  18«7. 

The  chapter  on  Phthisis  Is  replete  with  Interest; 
and  bis  remark*  on  the  diagnoni*.  especially  in  the 
early  stages,  are  remarkable  for  their  acumen  and 


, 
ct,  and  to  alM  concise,  be:  v.l!lliv     ,,r 


M.-IK  and  uiirio- 

ny  works 

i  Medical  Prtus,  Feb.  6, 


lyie  i 


n,i 


elegant,  and  the  tone  of  freshness  and  originality 
which  pervades  his  whole  work  lend  an  additional 
force  to  its  thoroughly  practical  character,  which 
cannot  fail  to  obtain  for  it  a  place  as  a  standard  work 
,i«es  of  the  respiratory  system. — London 
Lancet,  Jan.  19,  1887. 

Thi*  is  an  admirable  hook.  Excellent  in  detail  and 
execution,  nothing  better  conld  he  desired  by  the 
practitioner.  Dr.  Flint  enriches  Ms  subject  with 
much  solid  and  not  a  little  original  observation.— 
Ranking' i  Abntract,  Jan.  1867. 


III  the  invaluable  work  before  n«,  we  have  a  book 
If   of  nearly  600  page*,  admirably  arranged, 
clear,  th.  p.m.-!.,  a!,  :  -.  without  pro- 

lixity: t-xlit  -.mi  topic  tonched  ;  a 

in  .LID.  :tinii'-<l  .>l>»ervation, 

which  dues  credit  to  its  author,  aud  reflects  honor  on 

£T  TIIK  SAVE  Al'TUOR.  

A  IMIACTK'AL  TIIKATISE  OX  TIIK  DIAGNOSIS,  PATHOLOGY, 

AND  TKKAT.MKNT  OF  DISEASES  OF  THE  HEART.     In  one  neat  octavo  volume  of 
nearly  500  pages,  with  a  plate ;  extra  cloth,  $3  50. 

W  >.  :m'riran  author 

u;   ni.«r.'  e\t«-a-ir>-ly  known,  "r 

ntry  than  Dr.  I 

Flint.     We  willingly  acknowledge  his  success,  more  , 
particularly  iu  the  vuluuic  on  diseases  of  the  heart,  in 


makingan  extended  personal  clinical  study  available 
for  purpo-e*  <>f  illustration,  in  connection  with  case* 
which  have  linen  reported  by  other  trustworthy  ob- 
servers.—Brit,,  and  fur.  Jfed.-Chir.  KtoUto. 


SJHAXBERS  (T.  A'.),  V.D., 

' '.;,  -      .      •          ,  H      .,v-(7,  Jjondiyn,  Ac. 

TIIK   INhKil-STloXS;  or,  Diseases  of  the  Digestive  Organs  Functionally 

Treated.     Second  American,  from  the  second  and  revised  English  Edition.     In  one  hand- 
some octavo  volume  of  over  300  pages,  extra  cloth,  $3  00.     (Now  Ready.) 

most  vivid  and  brilliant  of  living  and  practical  skill — that  bis  success  as  a  teacher  or 

•diieal  writers ;  and  here  he  aupplie*,  in  a  graphic  literary  expositor  of  the  medical  art  conMsts;  and  the 

.<,  bright  sketches  fn>rn  hi*  w.-il-  volume  before  us  is  a  better  illustration  than  its  an- 

k,  thor  has  yet  produced  of  the  rare  degree  in  which 

i«hes,  original,  brilliant,  and  iu-  tho«e  combined  qualities  are  at  his  command.     Next 

•  .'.     Everywhere  he  Is  er.»)  !.;<•.  ;u,.|  hj»  work  to  the  diseases  of  children,  there  is  no  subject  on 


A 

jert,  and  we  have  in  th 
which 

'.n  id. 

and  we  are  e 

praise.  — .V   J 


.IK  of  much  value. — 
irnn!,  Nov.  18«7. 
e  faculty  which    T»r. 
his  sub- 


which  the  young  practitioner  is  oftener  consulted,  or 
on  which  the  public  are  more  apt  to  form  their 
opinions  of  his  professional  skill,  than  the  various 
phenomena  of  indigestion.  Dr.  Chambers  cornea  most 


...  elements    opportunely  and  effectively  to  bis  assistance.    In  fact, 

'make  iTa  modeT  'of  its'  sort'  ~We'h  a  ve  perused  i  toere  are  >ew  situations  in  which  the  commencing 
1'iiiiv:  hiivi-  Ktiulied  every  page'  our  interest    practitioner  can  place  himself  in  which  Dr.  Cham- 
.  ,1  a«  we  p, •..o.-.-d^.l.    lt-r»'  conclusions  on  digestion  will  not  be  of  service. 
—London  Lancet,  February  23,  1867. 


ay  it  down  with  unqualified 
,r<l,  April  l.'i,  1867. 


It  i-  iu  tin-  <•  i 
•.preiwio 


l'i  nation  of  these  qualities—  clear  and 
,  with  thorough  scientific  knowledge 


This  Is  one  of  the  most  valuable  works  which  it 
has  ever  been  our  good  fortune  to  receive. — London 
Med.  Mirror,  Feb.  lsx>7. 


]>I;I.\TO.\  (\\-II.U.\M\  M.  //..  ;•'.  HJS, 

l.K(  TU1KS  ON   TIN:   IHSKASI-S  OK  TIIK   STOMACH;   with  an 

Introduction  on  it.<  Anatomy  and  Physiology.     From  the  second  and  enlarged  London  edi- 
t,  .n.     With  iMiistratiuns  ..u  «.,..•!       In  one  handsome  octavo  volume  of  about  300  pages, 
(.///>/  /.«.«, 

•  n  he  f  tin  f  A  m  ^re  f    11  t       t,l    I       I       T>  t       tn    1    t  rk"  In  rat      t  •        nT  i      t>  A 

•  t-  I  diagnos- 
tic*,—-1m.  J;ur«  •>/  ttie  Med.  Science*,  April,  ltx».     |  18«5. 


JjABERSffOff  (.«?.  O.),  M.  />. 

PA  TI  lo  L  OCir  A  I.  AND  PRACTICAL  o  I 'Si:  II  V  ATloNS  ON   DIS- 

THK  AF.IMKN  r  \IIV  CANAL,  'K-"|M1  \«i  TS.  STu.MM'll.  r.V'TM.  AND 
INil.>IIM  <  With  illu-tnitiong  on  wood.  In  one  hand^utue  octavo  volume  of  312 
pages,  extra  cloth.  $: 

TTUI  L),  M.D..  M.  /.'.  /.  .1.. 

-*•-*  Ph>,  ',,!. 

.  Li-:cTri;i:s  ON  TIIK  STUDY  OF  KKYKH.    iu  one  vol.  8vo.,  extra 

cloth,      (litaily  *r.) 


18 


HENRY  C.  LEA'S  PUBLICATIONS — (Practice  of  Medicine). 


ROBERTS  (  WILLIAM],  M.  D.. 

-*-  ^  Lecturer  on  Medicine  in  the  Manchester  School  of  Medicine,  &c. 

A  PRACTICAL  TREATISE   OX  URIXARY  AND   REXAL   DIS- 

EASES,  including  Urinary  Deposits.     Illustrated  by  numerous  cases  and  engravings.     In 
one  very  handsome  octavo  volume  of  516  pp.,  extra  cloth.     $4  50.     (Just  Issued.) 
In  carrying  out  this  design,  he  has  not  only  made  >  sive  work  on  urinary  and  renal  diseases,  considered 
good  use  of  his  own  practical  knowledge,  but  has  ;  in  their  strictly  practical  aspect,  that  we  possess  in 
brought  together  from  various  sources  a  vast  amount    the   English    language. — British    M&lical   Journal, 
of  information,  some  of  which  is  not  generally  pos-     Dec.  9, 1865. 


sessed  by  the  profession  in  this  country.  We  must 
now  bring  our  notice  of  this  book  to  a  close,  re- 
gretting only  that  we  are  obliged  to  resist  the  temp- 
tation of  giving  further  extracts  from  it.  Dr.  Roberts 
has  already  on  several  occasions  placed  before  the 
profession  the  results  of  researches  made  by  him  on 
various  points  connected  with  the  urine,  and  had  thus 
led  us  to  expect  from  him  something  good — in  which 
expectation  we  have  been  by  no  means  disappointed. 
The  book  is,  beyond  question,  the  most  comprehen- 


We  have  read  this  book  with  much  satisfaction. 
It  will  take  its  place  beside  the  bent  treatises  in  our 
language  upon  urinary  pathology  and  therapeutics. 
Not  the  least  of  its  merits  is  that  the  author,  unlike 
some  other  book-makers,  is  contented  to  withhold 
much  that  he  is  well  qualified  to  discuss  in  order  to 
impart  to  his  volume  such  a  strictly  practical  charac- 
ter as  cannot  fail  to  render  it  popular  among  British 
readers. — London  Med.  Times  and  Gazette,  MJtrch 
17,  1866. 


»%  "  Bird  on  Urinary  Deposit?,"  being  for  the  present  out  of  print,  gentlemen  will  find  in  the 
above  work  a  trustworthy  substitute. 


MORLAND  ON  RETENTION  IN  THE  BLOOD  OF 
THE  ELEMENTS  OF  THE  URINARY  SECRE- 
TION. 1  vol.  8vo.,  extra  cloth.  75  cents. 

BLOOD  AND   URINE  (MANUALS  ON).     By  J.  W. 


GRIFFTH,  G.  0.  REESE,  and  A.  MARKWICK.     1  vol. 
12mo.,  extra  cloth,  with  plates,    pp.  460.    $1  25. 
BUDD  ON  DISEASES  OF  THE  LIVER.  Third  edition. 
1  vol.  Svo. ,  extra  cloth,  with  four  beautifully  colored 
plates,  and  numerous  wood-cuts,     pp.  500.    $4  00. 


TONES  (C.  EANDFIELD),  M.  D., 

^  Physician  to  St.  Mary's  Hosjiital,  &c. 

CLIXICAL    OBSERVATIONS 

DISORDERS.     Second  American  Edition. 

extra  cloth,  $3  25.     (Just  Issued.) 
Taken  as  a  whole,  the  work  before  us  furnishes  a  ' 
short  but  reliable  account  of  the  pathology  and  treat- 
ment of  a  class  of  very  common  but  certainly  highly 
obscure  disorders.    The  advanced  student  will  fluid  it 
a  rich  mine  of  valuable  facts,  while  the  medical  prac- 
titioner will  derive  from  it  many  a  suggestive  hint  to  , 
aid  him  in  the  diagnosis  of  "nervous  cases,"  and  in 
determining  the  true  indications  for  their  ameliora- 
tion or  cure. — Amer.  Journ.  Med.  Set.,  Jan.  1S67. 


OX    FUXCTIOXTAL   XERYOUS 

In  one  handsome  octavo  volume  of  348  pages, 

We  must  cordially  recommend  it  to  the  profession 
of  this  country  as  supplying,  in  a  great  measure,  a 
deficiency  which  exists  in  the  medical  literature  of 
the  English  language. — Xew  York  3Itd.  Journ.,  April, 
1867. 

The  volume  is  a  most  admirable  one — full  of  hints 
and  practical  suggestions.  —  Canada  Med.  Journal, 
April,  1867. 


FA  PRISON'S  ESSAY  TOWARDS  A  CORRECT 
THEORY  OF  THE  NERVOUS  SYSTEM.  In  one 
octavo  volume  of  292  pp.  $1  50. 

SOLLY  ON  THE  HUMAN  BRAIN:  its  Structure,  Phy- 
siology, and  Diseases.  From  the  Second  and  much 
enlarged  London  edition.  In  one  octavo  volume  of 
500 pages, with  120 wood-cuts;  extra  cloth.  $250. 


BUCKNILL  AND  TUKE'S  MANUAL  OF  PSYCHO- 
LOGICAL MEDICINE;  containing  the  History, 
Nosology,  Description,  Statistics,  Diagnosis,  Patho- 
logy, and  Treatment  of  Insanity.  With  a  Plate, 
lu  one  handsome  octavo  volume,  of  53ti  pages,  extra 
cloth.  $1  25. 


8 


LADE  (D.  D.),  M.D. 

DIPHTHERIA ;  its  X"ature  and  Treatment,  with  an  account  of  the  His- 
tory of  its  Prevalence  in  various  Countries.  Second  and  revised  edition.  In  one  neat 
royal  12mo.  volume,  extra  cloth.  $1  25.  (Just  issued.) 


SMITH  OX  CONSUMPTION  ;  ITS  EARLY  AND  RE- 
MEDIABLE STAGES.  In  one  neat  octavo  volume 
of  254  pages,  extra  cloth.  $2  25. 

SALTER  ON  ASTHMA  ;  its  Pathology,  Causes,  Con- 
sequences, and  Treatment.  In  one  volume  octavo, 
extra  cloth.  $2  50. 

BUCKLER  ON  FIBRO-BRONCHITIS  AND  RHEU- 
MATIC PNEUMONIA.  In  one  octavo  vol.,  extra 
cloth,  pp.  150.  SI  25. 

FISKE  FUND  PRIZE  ESSAYS.— LEE  ON  THE  EF- 
FECTS OF  CLIMATE  ON  TUBERCULOUS  DIS- 
EASE. AND  WARREN  ON  THE  INFLUENCE  OF 


PREGNANCY  ON  THE  DEVELOPMENT  OF  TU- 
BERCLES. Together  in  one  neat  octavo  volume 
extra  cloth,  *1  00. 

HUGHES'  CLINICAL  INTRODUCTION  TO  AUS- 
CULTATION AND  OTHER  MODES  OF  PHYSICAL 
DIAGNOSIS.  Second  edition.  One  volume  royal 
12mo..  extra  cloth,  pp.  304.  $1  25. 

WALSHE'S  PRACTICAL  TREATISE  ON  THE  DIS- 
EASES OF  THE  HEART  AND  GREAT  VESSELS. 
Third  American,  from  the  third  revised  and  much 
enlarged  London  edition.  In  one  handsome  octavo 
volume  of  420  pages,  extra  cloth.  $3  00. 


(ROBERT  D.},  K.  C.  C. 
A  TREATISE  OX  FEVER;  or,  Selections  from  a  Course  of  Lectures 

on  Fever.    Being  part  of  a  Course  of  Theory  and  Practice  of  Medicine.    In  one  neat  octavo 
volume,  of  362  pages,  extra  cloth.     $2  25. 


CLYMER  ON  FEVERS;  THEIR  DIAGNOSIS,  PA- 
THOLOGY AND  TREATMENT.  In  one  octavo  volume 
of  600  pages,  leather  *1  75. 

TODD'S  CLINICAL  LECTURES  ON  CERTAIN  ACUTE 
DISEASES.  In  one  neat  octavo  volume,  of  320  pages, 
extra  cloth.  *2  50 

LA  ROCHE  ON  YELLOW  FEVER,  considered  in  its 
Historical,  Pathological,  Etiological,  and  Therapeu- 
tical Relations.  Including  a  Sketch  of  the  Disease 
as  it  has  occurred  in  Philadelphia  from  1699  to  1854, 


with  an  examination  of  the  connections  between  it 
and  the  fevers  known  under  thesame  name  in  other 
parts  of  temperate  as  well  as  in  tropical  regions. 
In  two  large  and  handsome  octav,o  volumes,  of 
nearly  1500  pages,  extra  cloth,  $7  00. 
LA  ROCHE  ON  P NEUMONIA  ;  its  Supposed  Connec- 
tion, Pathological,  and  Etiological.  with  Autumnal 
Fevi-rs,  including  an  Inquiry  into  the  Existencefcnd 
Morbid  Agency  of  Malaria.  In  one  handsome  oc- 
tavo volume,  extra  cloth,  of  500  pages.  Price  &3  00. 


HKNRY  C.  LEA'S  PUBLICATIONS — (Vcntn-al  Diseases,  etc.). 


19 


T>  UM.<  /7-:, \  /)  ( /•'/,'  r.KMAN  J.),  At.  D.t 

•*-*        Professor  nf  Venereal  Diseases  at  the  Col.  of  Phys.  and  Surg.,  Kete  Tort.  Ac. 

THE  PATHOLOGY  AND  TKKATMKNT  OF  VKNKREAL  DIS- 

I    \- :  3.     Including  the  results  of  recent  investigations  upon  the  subject.     A  new  and  re- 
vised e<liti»n,  with  illustration*.     In  one  large  and  handsome  octavo  volume  of  640  pages, 
extra  cloth,  $5  00.     (Lately  Itiued.) 
Well  known  as  one  of  the.  b"»t  authorities  of  the  (  which  bM  long  been  felt  in  Eoglluk  medical  literature. 


present  day  on  the  subject.  —  British  and  fur.  Jfed.- 


•y. 


,  April,  1866. 


•  m*e  of  special  Information.  — 


f 


1866. 


A  remarkably  clear  and  foil  systematic  treatise  on 


—Brit,  and  Foreign  Med.-CMrurg.  Review,  Jan.,  '65. 

We  bare  not  net  with  any  which  no  highly  merits 
our  approval  and  praUe  as  the  second  edition  of  Dr. 
liu  in  ;•  tfitd'a  work. — Glasgow  Mtd.  Journal,  Oct.  18«4. 

We  know  of  no  treatise  In  any  language  which  la 


the  whole  subject. — Lond.  Med.  Tinirs  and  Satette.  \  Its  equal  in  point  of  completeness  and  practical  sim- 


Tlie  b««t,  competent,  fullest    nioii.>Kraph  on  this 
•abject  in  our  language. — British  American  J'.unml. 

s  medicaj  library. — Pacijtc  Jfed. 
j.  J'l'irn-il. 

We  have  no  doubt  that  It  will  supersede  In  America 
•Terr  nther   treatise  on  Venereal. — Sun  Francisco 

. 

t-.on  of  Ml  that  1*  worth  knowing 
•e«  in  general.     It  fllU  up  a  gap 


5liciiy. —  HiHttvii  Mtdical  and'  Surgical  Journal, 
an.  30,  1S64. 

The  book  Is  one  which  every  practitioner  should 
have  in  his  possession,  and,  we  may  further  say,  the 
fluty  book  upon  the  subject  which  he  should  acknow- 
ledge as  competent  authority. — Buffalo  Medical  and 
Surgicul  Journal,  July,  1864. 

The  best  work  with  which  we  are  acquainted,  and 
the  most  convenient  hand-book  for  the  busy  practi- 
tioner—Cincinnati  Lancet,  July,  1S64. 


riULLERIER  (A.}.  and 

V  tltt  llopital  dit  Midi. 


J>  I  MSTEA  D  (FREE MA  N  J. ), 

•*-*       Profr*M>r  <>f  Venerea  I  Diseases  In  Hie  College  of 
Physicians  and  Surgeons,  Jf.  T. 

AN     ATLAS    OF    VKNKIIKAL    1USKASKS.      Translated   and    Edited    by 

KAJ  J.  lie M STEAD.     In  one  large  imperial  4to.  volume  of  328  pages,  double-columns, 
with  2«  plates,  containing  about  150  figures,  beautifully  colored,  many  of  them  the  size  of 
troi  :'\   i  ..mill  in  extra  cloth,  $17  00  ;  also,  in  five  parts,  stout  wrappers  for  mailing,  at 
'.      (Just  Heady.) 

As  the  successor  of  Ricord  in  the  great  Venereal  Hospital  of  Paris,  M.  Cullerier  has  enjoyed 
special  ndviiuta<:«-s  for  the  present  undertaking,  and  bis  series  of  illustrations,  though  only  recently 
tini-hf  1.  is  already  recognized  as  tbe  most  complete  and  comprehensive  that  bus  yet  appeared  on 
Uii.-  .-nl  jeft.  In  reproducing  these  plates  every  care  has  been  had  to  preserve  their  artistic  finish 
and  nccurnry,  and  they  are  confidently  presented  as  equal  to  anything  that  has  yet  been  produced 
in  tin?  country.  The  reputation  of  Dr.  Bum.'tead  as  a  writer  and  syphilographer  is  too  well  known 
to  require  ntlirr  guarantee  for  tbe  fidelity  of  the  translation  or  the  value  of  the  additions  introduced. 

Antici|i:itin;_'  a  very  larjrc  .=:tle  for  this  work,  it  is  offered  at  the  very  low  price  of  THREE  DOL- 
.  thus  |.!:i--in^  it  within  the  reach  of  all  who  are  interested  in  this  department  of  prac- 
tice, fit- ntlnnu-n  desiring  early  impressions  of  the  plates  would  do  well  to  order  it  without  delay. 

*#*  A  «pecimen  of  the  plates  and  text  gent  free  by  mail,  on  receipt  of  25  cents. 


Thin  |<  a  v.-ry  hrtii'lsDiiu 
well-known  and  highly  va 
That  !•  :  the  ant 

.41;. I  ••  :   '   ::. 

• 

Its  rnmplu 
ophtlialmii 
••cilte-i.  h 
of  th.-  kiu.l 


dition  in  Ku-.-li-li  of  .. 
highly  valued  French  publication. 
d.  the  an-  -r  the  best  and 

itise  on  venereal  diseases   in   the 
••!>.. iil.l  think  it  proper  to  translate  I 
peak*  more  highly  In  its  favor  than  I 
It  in  a  judgment  ex  at-  ' 
-'.it:. in  i<  an  excellent  on*.     The  I 
1   lilennorrhagia  and 

rrhceal  I 

'are  admirably  and  artistically  ex- 
try.     The 


••I      III'      K1UII     Ullll**l|lf     f-A'^lll^ll      IU      lllls    ItiliullJ.  A  UD 

y  lir    DMIII-  •   tin-  value  of 

the  work.    'I  ttlnf-np  of  tbU  pabltoation 

•erned.— .<//.  Vrd.  Sciences,  Apri 

A  ms^niticput  work,  in  llip   bc»t  Ktylo  nf 

illn«tr...  . ;/.,  M.,i.  J'.'irn'il.  April,  l-'iv 

W.-  ,i  .  all  the  attention  of  ( 

tin-  prnft>— .I.M.  Taiin-   .if  tlil.t    ni.ivtiiflcent  ' 
Work.     The    pUten  in  dimmo-ln liography  urn  most  I 

admira:  .ilily  in 

diiitini  riginals,  as  we 


know  from  personal  examination.  The  appearance  of 
the  work  in  parts  places  it  within  tbe  reach  of  all,  and 
when  completed  it  will  be  a  m»nt  valuable  accession 
to  our  literature.— .V.  1".  Mtd.  Journal,  April,  1868. 

This  is  probably  the  handsomest  work  of  Its  class 
ever  published  in  this  country. — Eostun  Med,  and 
Surg.  Journal,  April  1.1, 

Tho  two  parts  thus  pablinhod  are  Illustrated  by 
plates,  than  which  none  Kuperlor  have  been  issued 
from  the  press;  in  fact,  in  this  country,  no  more 
magnificent  work  has  ever  been  published.  Infinite 
-  dne  the  publisher  and  translator  that  they 
should  have  placed  before  tbe  profession,  in  Mich  a 
style,  so  valuable  a  production. — St.  Louis  Med.  .Re- 
May,  1S6S. 

This  in  one  of  the  most  elegantly  published  and 
valuable  works  that  have  been  lepriottxl  and  edited 
in  this  country,  relating  to  the  loathsome,  though  im- 
portant, class  of  vf  uereal  diseases.  The  author  and 
iMitor  are  alike  men  of  experience  and  eminent  abi- 
lity ;  and  we  freely  com  mm  I  tin-  pr.nl  net  of  thfir 
labon  to  the  general  patronage  of  the  profession. — 
/Vii.-iy,,  M.,f  May,  1868. 


ALLBMAND   A\I>   U7/,X".v. 

'A    PRACTICAL   TI'J-ATISK    ()\    T1IK     OAtTSES,    SYMPTOMS. 

ANI»   THKATMKXT    <>F    H'Ul.MAT- iliKIHK  \.      I'.v   M    L.u.LEMAsn.     Tran.slnted  and 

edited  lir  Hr!»RV  J.  M'  I'"'  <:  M  t.       Fifth  Aniericnn  e.lition.     To  which  i*  addril ">N 

-OFTHK  VE8ICUL2B   <KM  IN  \  I.KS.  AMI  TIIKIK  ASS...-HTKI.  ,.i!(;  \xs.    With 

il  ri-:'fi«-ncf  to  t!  Tftions  nf  the  I'ro-tMtii-  and  I'rctliral  Mucous  McinKrane. 

K\  .M  \  i:.. i  -,  \V  :  i.>i>,  M.I>.    In  one  neat  octavo  volume,  of  about  400  pp.,  extra  cloth,  $2  75. 


LL  (BE RKELET), 

S'lr  . 

ON   SVI'IIII.IS    AND    LOCAL   CONTAGIOUS    DISOIIPKILS.     In 

one  handsome  octavo  volume.     (Nearly  Ready.) 


20 


HENRY  C.  LEA'S  PUBLICATIONS — (Diseases  of  the  Skin). 


WILSON  (ERASMUS),  F.R.S., 

ON  DISEASES  OF  THE  SKIN.     With  Illustrations  on  wood.    Sev- 

enth  American,  from  the  sixth  and  enlarged  English  edition.     In  one  large  octavo  volume 
of  over  800  pages,  $5.     (Now  Ready.) 

A  SERIES  OF  PLATES  ILLUSTRATING  "WILSON  ON  DIS- 
EASES OF  THE  SKIN;"  consisting  of  twenty  beautifully  executed  plates,  of  which  thir- 
teen are  exquisitely  colored,  presenting  the  Normal  Anatomy  and  Pathology  of  the  Skin, 
and  embracing  accurate  representations  of  about  one  hundred  varieties  of  disease,  most  of 
them  the  size  of  nature.  Price,  in  extra  cloth,  $5  50. 
Also,  the  Text  and  Plates,  bound  in  one  handsome  volume.  Extra  cloth,  $10. 

From  the  Preface  to  the  Sixth  English  Edition. 

The  present  edition  has  been  carefully  revised,  in  many  parts  rewritten,  nnd  our  attention  h;is 
been  specially  directed  to  the  practical  application  and  improvements  of  treatment.  And,  in 
conclusion,  we  venture  to  remark  that  if  an  acute  and  friendly  critic  should  discover  any  differ- 
ence between  our  present  opinions  and  those  announced  in  former  editions,  we  have  only  to  ob« 
serve  that  science  and  knowledge  are  progressive,  and  that  we  have  done  our  best  to  move  onward 
with  the  times. 

The  industry  and  care  with  which  the  author  has  revised  the  present  edition  are  shown  by  the 
fact  that  the  volume  has  been  enlarged  by  more  than  a  hundred  pages.  In  its  present  improved 
form  it  will  therefore  doubtless  retain  the  position  which  it  has  acquired  as  a  standard  and  classical 
authority,  while  at  the  same  time  it  has  additional  claims  on  the  attention  of  the  profession  as 
the  latest  and  most  complete  work  on  the  subject  in  the  English  language. 


Such  a  work  as  the  one  before  us  is  a  most  capital 
and  acceptable  help.  Mr.  Wilson  has  long  been  held 
as  high  authority  in  this  department  of  medicine,  and 
his  hook  on  diseases  of  the  skin  has  long  been  re- 
garded as  one  of  the  best  text-books  extant  on  the 
subject.  The  present  edition  is  carefully  prepared, 
and  brought  up  in  its  revision  to  the  present  time.  In 
this  edition  we  have  also  included  the  beautiful  series 
of  plates  illustrative  of  the  text,  and  in  the  last  edi- 
tion published  separately.  There  are  twenty  of  these 
plates,  nearly  all  of  them  colored  to  nature,  and  ex- 
hibiting with  great  fidelity  the  various  groups  of 
diseases  treated  of  in  the  body  of  the  work.  —  Cin- 
cinnati Lancet,  June,  1863. 

No  one  treating  skin  diseases  should  be  without 
a  copy  of  this  standard  work.  —  Canada  Lancet. 
August,  1863. 

Y  THE  SAME  AUTHOR.  — 


We  can  safely  recommend  it  to  the  profession  &8 
the  best  work  on  the  subject  now  in  existence  in 
the  English  language. — Medical  Times  and  Gazette. 

Mr.  Wilson's  volume  is  an  excellent  digest  of  the 
actual  amount  of  knowledge  of  cutaneous  diseases ; 
it  includes  almost  every  fact  or  opinion  of  importance 
connected  with  the  anatomy  and  pathology  of  the 
skin. — British  and  Foreign  Medical  Review. 

These  plates  are  very  accurate,  and  are  executed 
with  an  elegance  and  taste  which  are  highly  creditable 
to  the  artistic  skill  of  the  American  artist  who  executed 
them. — St.  Louis  Med.  Journal. 

The  drawings  are  very  perfect,  and  the  finish  and 
coloring  artistic  and  correct;  the  volume  is  an  indis- 
pensable companion  to  the  book  it  illustrates  and 
completes. — Charleston  Medical  Journal. 


THE  STUDENT'S  BOOK  OF  CUTANEOUS  MEDICINE  and  Dis- 

EASES  OF  THE  SKIN.    In  one  very  handsome  royal  12mo.  volume.    $350.    (Lately  Issued.) 
Y  THE  SAME  AUTHOR.  - 

HEALTHY  SKIN;   a  Popular  Treatise  on  the  Skin  and  Hair,  their 

Preservation  and  Management.     One  vol.  12mo.,  pp.  291,  with  illustrations,  cloth.     $1  00. 


(J.  MOORE),  M.D.,  M.R.I.  A., 
A    PRACTICAL    TREATISE    ON    DISEASES    OF    THE    SKIN. 

Fifth  American,  from  the  second  and  enlarged  Dublin  edition  by  T.  W.  Belcher,  M.  D. 
In  one  neat  royal  12mo.  volume  of  462  pages,  extra  cloth.     $2  25.     (Just  Issued.) 

Of  the  remainder  of  the  work  we  have  nothing  be-  :  This  instructive  little  volume  appears  once  more. 
yond  unqualified  commendation  to  offer.  It  is  so  far  Since  the  death  of  its  distinguished  author,  the  study 
the  most  complete  one  of  its  size  that  has  appeared,  of  skin  diseases  has  been  considerably  advanced,  and 
and  for  the  student  there  can  be  none  which  can  com-  '  the  results  of  these  investigations  have  been  added 
pare  with  it  in  practical  value.  All  the  late  disco-  by  the  present  editor  to  the  original  work  of  Dr.  Neli- 
veries  in  Dermatology  have  been  duly  noticed,  and  gan.  This,  however,  has  not  so  far  increased  its  bulk 
their  value  justly  estimated;  in  a  word,  the  work  is  as  to  destroy  its  reputation  as  the  most  convenient 
fully  up.  to  the  times,  and  is  thoroughly  stocked  with  manual  of  disease*  of  the  skin  that  can  be  procured 
most  valuable  information.  —  New  i'ork  Med.  Record,  by  the  student.  —  Chicago  Med.  Journal,  Dec.  1S66. 
J«n.  15,  1867.  i 

£Y  THE  SAME  AUTHOR.  - 

ATLAS   OF   CUTANEOUS    DISEASES.     In   one  beautiful   quarto 

volume,  with  exquisitely  colored  plates,  <tc.,  presenting  about  one  hundred  varieties  of 
disease.     Extra  cloth,  $5  50. 

The  diagnosis  of  eruptive  disease,  however,  under  1  Inclined  to  consider  it  a  very  superior  work,  com- 
all   circumstances,   is   very  difficult.     Nevertheless,  |  bining  accurate  verbal  description  with  sound  views 


Dr.  Neligan  has  certainly,  "as  far  as  possible,"  given 
a  faithful  and  accurate  representation  of  this  class  of 
diseases,  and  there  can  be  no  doubt  that  these  plates 
will  be  of  great  use  to  the  student  and  practitioner  in 
drawing  a  diagnosis  as  to  the  class,  order,  and  species 
to  which  the  particular  case  may  belong.  While 
looking  over  the  "Atlas"  we  have  been  induced  to 
examine  also  the  "Practical  Treatise,"  and  we  are 


of  the  pathology  and  treatment  of  eruptive  diseases. 
— Glasgow  tied.  Journal. 

A  compend  which  will  very  much  aid  the  practi- 
tioner.in  this  difficult  branch  of  diagnosis.  Taken 
with  the  beautiful  plates  of  the  Atlas,  which  are  re- 
rmirkable  for  their  accuracy  and  brauty  of  coloring, 
it  constitutes  a  very  valuable  addition  to  the  library 
of  a  practical  man. — Buffalo  Med.  Journal. 


TJILLIER  (THOMAS),  M.D., 

•*--*-  Physician  to  the  Skin  Department  of  University  College  Hospital,  &c. 

HAND-BOOK  OF  SKIN  DISEASES,  for  Students  and  Practitioners. 

In  one  neat  royal  12mo.  volume  of  about  300  pages,  with  two  plates;  extra  cloth,  $2  25. 
(Just  Issued.) 


HKN-RY  C.  LEA'S  PUBLICATIONS — (Diseases  of  Children).  21 

SJONDIE  (D.  FRANCIS),  M.  D. 
A  PRACTICAL  TKKATISK  ON  THK   DISKASES  OF  CII I  LIUIKN. 

M  \ih  edition,  revised  and  augmented.     In  one  large  octavo  volume  of  nearly  800  closely- 
printed  pages,  extra  cloth,  $5  25  ;  leather,  $o  25.       (Now  Ready.) 
From  the  Author'1 »  Preface. 

In  prepnrinp  for  the  press  this  sixth  edition  of  his  treatise  on  the  Diseases  of  Children,  the  great 
aim  of  the  author  has  been  to  present  a  complete  and  faithful  exposition  of  the  pathology  and 
•hf  maladies   incident  to  the  earlier  stages  of  existence.     The  entire  work  has 
inide-  .  fill  and  thorough  revision  ;  while  in  the  different  sections  has  been  incorporated 

nnportnnt  observation  in  reference  to  the  diseases  of  which  they  treat,  that  has  been  re- 
corded Mnce  the  apjKMrance  of  the  last  edition.  Every  effort  has  been  made,  and  every  available 
source  of  information  soupht  after,  to  render  the  treatise  a  reliable  and  useful  guide  to  the  actual 
state  of  medical  knowledge  in  reference  to  all  those  diseases  which  either  exclusively  or  most  usu- 
ally occur  between  birth  and  puberty— disease?  which  form,  in  some  degree,  a  class  apart  from 
those  of  the  adult — and  demand  for  their  cure  a  particular  plan  of  treatment. 

Dr.  Condie  baa  been  one  of  those  who  have  per-  days  by  wandering  through  its  pages,  and  at  the  same 
i  a  service  satisfactorily,  and,  a*  a  result,    time  to  be  able  to  recommend  it  to  the  youngest  mem- 
bers of  tbe  profession,  as  well  aa  to  those  who  have 
the  older  editions  on  their  shelves. — St.  Loult  Meet. 
Reporter,  Feb.  15,  1868. 


work  has 

on  the 

incontes- 


1  forth.    Tbe  pret--  «  hirh  i«  the 

-.illv  up  t..  it,.-  tin..-,  in  .1,..  .li,r,,..i,,n  of  all      J116  work.  °f  Dr-  C?ndlf  l?  unquestionably  a  very 
••«y  and  treatment  of  infan-    fble  one-    "  is  Practical  In  its  character,  as  it*  title 
•I  by  the    """port*!  bat  the  practical  precept*  recommended  in 
..wHvcr     it  are  baaed,  as  all  practice  should  be,  npon  a  familial 

the  w  irk  i,  the  best  Am*-!  ive  and    knowledge  of  disease.    The  opportunities  of  Dr.  C"u- 

riran  practitioners  It    j|ie  for  the  practical  study  of  tbe  diseases  of  children 

iu.il.-Acw   lurk  M-,1.  Record,    havebeen  great,  and  hU  work  i»  a  proof  that  they  have 

not  been  thrown  away.    He  has  read  much,  bnt  ob- 

.    served  more;  and  we  think  that  we  mar  safely  say 

Ko  other  tr,.stl.e  on  this  subject    a  better  adapted    that  the  Amerlcan  8tn(,ent  canuot  flnd/in  hi«  own 
J"!110  vMcmn.    I)r.(,ondieba»  long  stood    language,  a  better  book  npon  the  subject  of  which  it 

before  Ma  conntrymen  a8  one  pecnliarly  pre-eminont    treats.-^m.  Journal  Medical  Science*. 

llm  work  has  been  | 

.  a  itandard  for  practiiiooers  and  inHical  «tn-        We  pronounced  the  first  edition  to  be  the  bent  work 
•   now  than  r-  fer  to  the  fact    on  the  diseases  Of  children  in  the  Englixh  langvage, 

that  it  hns  r>-.irh.><l  it-  -ixtli  o<lition.     We  are  glad     and,  notwithstanding*!!  that  haa  been  pnhlisbed,  w« 
•  »  to  refresh  the  imprexsiuns  of  our  earlier  ,  Mtill  regard  it  iu  that  light.  —  Medical  Kxumintr. 


S.M///7/  .r.  LEWIS],  M.D., 

*3  i'ruftstnr  of  Morbid  Anatomy  in  the  Bf.llevue  ffotpital  Jfed.  CnTlege,  tf   T. 

ACOMI'IJITK  IMIACTICALTREATISK  <>\  TIIK  HFSKASESOF 

<  HlI.l/KKN.  In  one  large  octavo  volume  of  about  850  pages.  (Nearly  Ready.) 
The  object  of  the  author  has  been  to  present  within  a  moderate  compass  a  complete  but  concise 
account  of  the  pathology  and  therapeutics  of  the  diseases  incident  to  infancy  and  childhood,  M 
viewed  from  the  standpoint  of  the  most  advanced  condition  of  medical  science.  The  unusual 
opportunities  which  he  has  enjoyed  of  clinical  observation  in  public  and  private  practice  cannot 
fail  to  render  the  work  one  of  great  practical  value. 

WEST  (  CH.\  /,'  /,  /•>'),  M.  D~ 

Phytii-tnn  to  the  ll<,*i>it'tlfnr  Sick  (Children,  Ac. 

LKCTTIIKS   ON    TIIK    IHSKASES   OF   INFANCY  AND  CHILD- 

HOOD.  Fourth  American  from  the  fifth  revised  and  enlarged  English  edition.  In  on« 
large  and  handsome  o«tavo  volume  of  650  closely-printed  pages.  Extra  cloth,  $4  50  ; 
leather,  $5  50.  (Just  itfiied.) 


Of  ill  the  EoKlinh  writer*  on  the  diHt-tn^s  of  cbll-  1  affording  the  readermnch  pleasure,  even  Indepflndea 

dron,  there  in  no  one  no  entirely  .,iiti-f;ici..rv  I.,  n-*  a«     of  that  «  -  i  roin  the  acquihition  of  valuable 

in  we  hav.  i.iion  as  ;  tm\b»,—  Cincinnati  Jour,  of  Medicine,  March,  ISM. 

r  llm  l,i«h.-,t        We  hfcTe  ,        ^^,-ded  lt  „  th(,  mtni  Dentine  and 

lit   ?!  u^  ^  .1  ^TivTn  wn      II  :    P~c"«>  '"'^  "»  'l,^a«..  of  children  which  has  yet 
' 


1  bv  a,d  .raca.  com 


ln  tbl»  «oantry.-fi»/«io  Mtdic.il  Journal. 
'-tf*  book  i.-  tli.<  l-.--t  that  has  ever  been 
in  the  Knqlixh  IHIUUMI;**  on  the  di«ea«e«  of 
•»  all  a*  am  ••"•'  chlldhoo-l  .  —  i  '  •!H,H>IUI  Rtvicto  of  Mtd. 

•Maatoni  when  n»<  «aBM  rabjer  :<ry. 

:.>il  to  help  u-  uno  part  of  the  volume,  no  subject  on  which 

r:tl  index,  and  a  «pecial  li  r-    j|  ir.-at,  which  does  not  exhibit  the  keen  perception, 

rnnln-  work.—  Botton  Mtd.    (i,.  ,,f  the 

Dr.  \\>«t'K  rolame  Is,  In  onr  opinion,  locomi  in  hit  management 

• 
that   • 

- 
• 
• 


D 


E  WEES  (\\-II.I.L\M  1\  .  M./>.. 

I  •  ,,/  r. 

A    TREATISE   ON    THK    PHYSICAL    AND    MKDICAL    TP.KAT- 

I    "K  i  IHI.l'KKN.     Eleventh  edit!  >n,  with  the  author's  last  improvements  and  cor- 
rections.    In  one  octavo  volume  of  54vs  jmges.     $2  80. 


22 


HENRY  C.  LEA'S  PUBLICATIONS — (Diseases  of  Women). 


ITHOMAS  (T.GAILLARD\M.D., 

-*-  Professor  of  Obstetrics,  &c  in  the  College  of  Physicians  and  Surgeons,  N.  Y.,  &c. 

A  PRACTICAL  TREATISE  OX  THE  DISEASES  OF  WOMEN.     In 

one  large  and  handsome  octavo  volume  of  over  600  pages,  with  219  illustrations,  extra 
cloth,  $5;  leather,  $6.     (Now  Ready.) 

From  the,  Preface. 

"  This  work  was  undertaken  with  the  conviction  that  a  treatise,  such  as  that  which  the  Author 
has  aimed  to  prepare,  was  needed  as  a  text-book  for  the  American  student,  and  as  a  book  of 
reference  for  the  busy  practitioner. 

"No  department  of  medicine  has  made  greater  advances  within  the  last  few  years  than  Gyne- 
cology ;  yet  the  record  of  its  progress  is,  for  the  most  part,  to  be  found  only  in  special  monographs, 
journals,  transactions  of  societies,  &c.,  and  is  thus  inaccessible  to  the  mass  of  the  profession  in 
this  country.  It  has,  therefore,  seemed  to  the  author  that  a  volume  which  should,  within  a 
limited  space,  present  the  latest  aspect  of  the  subject  in  a  systematic  form,  could  scarcely  fail  to 
prove  useful,  while  his  position  for  the  last  thirteen  years  as  a  teacher  in  this  department  has 
encouraged  him,  in  the  hope  that  his  familiarity  with  the  needs  of  the  student  may,  to  some  extent, 
have  fitted  him  to  undertake  the  task." 

The  best  text-book  for  students,  and  a  perfect  wide  completeness,  a  clearness  and  simplicity,  to  be  found 
mecum  to  the  gynecologist. — 2f.  Y.  Journal  of  O'juttt-  in  no  other  book  on  the  same  subject  within  our 


rics,  May,  1S68. 


knowledge ;  its  views  on  uterine  pathology  are,  to 


We  have  recently  been  almost  flooded  by  works  our  lnind.  more  consonant  with  reason  and  common 
from  American  sources  on  the  allied  subjects  of  ob-  :  8en8e  tban  any  other  we  have  8een-  Enjoying  fine 
stetricsandgynecoloey.  Nor  hasquantity  alone  been  opportunities  in  an  extensive  field  of  observation  Dr. 
the  most  noticeable  feature  connected  with  them,  for  Thomas,  as  an  author,  has  fully  sustained  his  high 
their  quality  has  invariablv  been  of  the  highest.  Dr.  reputation  as  a  teacher.  We  have  no  hesitation  in 


great  clinical  experie 

illustrated  by  upwards  of  two  hundred  engravings,  .  In  no  work  with  which  we  are  acquainted,  is  there 
some  of  them  of  great  value. — London  lied.  Times  to  be  found  so  full  and  complete  an  exhibit  of  the  im- 
and  Oaz.,  April  25,  1868.  !  proved  means  of  diagnosis  of  the  obscure  subjects  of 

The  book  of  Prof.  Thomas  is  well  calculated  to  do  gynecology,  or  of  their  more  enlightened  therapy, 
away  with  this  latter  objection,  and  to  accomplish  Dili  our  sPace  permit,  we  should  be  glad  to  go  into  an 
more  towards  the  establishment  of  a  rational  system  extended  review  of  the  work  hefore  us,  giving  not 
of  uterine  therapeutics  than  any  other  work  of  its  merely  an  outline  of  the  sul.jects  treated  of,  but  lull 
size  in  any  language.  We-have  rarely  read  any  trea-  extracts  from  the  text  itselt.  As  it  is,  we  can  only 
Use  upon  a  medical  topic  that  has  given  us  better  recommend  our  readers  to  buy  it,  feeling  convinced 
satisfaction,  or  impressed  us  with  the  fitness  of  an  au-  ,  «hey  win  te  amply  repaid  for  the  outlay.— Z,«ui>*n- 
thor  for  the  proper  performance  of  a  most  responsible  «WW  Medical  Herald,  May,  1868. 
task  Itisperhaps  unnecessary  for  us  to  commend  the  Indeed,  we  do  not  know  a  better  study  in  briefer 
work  most  heartily  to  every  one  who  is  or  may  be  gpacei  no't  for  medical  students  merely,  but  for  prac- 
hable  to  treat  uterine  diseases.— N.  York  Medical  Be-  tfaoners,  who  may  really  wish  to  have  light  upon  an 
cord,  April  lo,  1868.  .  obscure  pathway,  to  be 'trained  in  the  thorough  in- 

A  work  which  will  certainly  add  to  the  reputation     vestigation   of   diseases  peculiar  to  women,  than  is 
of  its  author,  and  come  into  general  use  in  this  coun-    herein  to  be  found. —  Western  Journal  «/  Medicine, 
try  as  a  text-book.     The  style  is  exceedingly  clear    May,  1868. 
and  concise,  and  the  views  expressed  eminently  prac-  j 

tical  and  scientific.— Quarterly  Journ.  of  Psychul.  It  is  a  masterly  resume  of  what  is  known  by  an 
Medicine  April  1S6S  experienced  and  honest  observer.  The  Profession 

:  is  indebted  to  Prof.  Thomas  for  thus  tabulating  the 

The  work  is  concise  and  practical,  avoiding  the  dis-  much  that  has  been  accepted  as  valuable  and  reliable 
cussion  of  unsettled  questions  but  giving  a  judicious  in  gynecology,  but  this  is  not  by  any  means  all  the 
resume  of  known  facts.— Chicago  Med.  Journal,  me*?t  of  th|  work  ;  we  have  his  ample  experience, 
April,  186S.  i  given  jn  jjjs  opinions  on  pathology  and  treatment, 

We  are  led  to  believe  that  it  is  the  best  work  that  which  carry  conviction  by  the  confidence  we  feel  that 
has  yet  appeared  on  the  diseases  of  women.  There  they  are  the  candid  opinions  of  an  honest  and  compe- 
ls about  it  a  precision  and  accuracy,  a  fulness  and  tent  observer. — Humboldt  Med.  Archives,  April,  1863. 


HUE  CHILL  (FLEETWOOD),  M.  D.,  M.  R.  I.  A. 

OX  THE  DISEASES    OF  WOMEN;    including  those  of  Pregnancy 

and  Childbed.    A  new  American  edition,  revised  by  the  Author.    With  Notes  and  Additions, 
by  D.  FRANCIS   COXDIE,  M.  D.  ,  author  of  "  A  Practical  Treatise  on  the  Diseases  of  Chil- 
dren."    With  numerous  illustrations.      In  one  large  and  handsome  octavo  volume  of  768 
pages,  extra  cloth,  $4  00;  leather,  $5  00. 
Y  THE  SAME  A  UTHOR. 

ESSAYS  OX    THE   PUERPERAL    FEVER,  AXD    OTHER   DIS- 

EASES PECULIAR  TO  WOMEN.  Selected  from  the  writings  of  British  Authors  previ- 
ous to  the  close  of  the  Eighteenth  Century.  In  one  neat  octavo  volume  of  about  450 
pages,  extra  cloth.  $2  50. 


BROWN  OX  SOME  DISEASES  OF  WOMEN  AD- 
MITTING OF  SURGICAL  TREATMENT.  With 
handsome  illustrations.  One  volume  8vo.,  extra 
cloth,  pp.  276.  $1  60. 

ASHWELL'S  PRACTICAL  TREATISE  ON  THE  DIS- 
EASES PECULIAR  TO  WOMEN.  Illustrated  by 
Cases  derived  from  Hospital  and  Private  Practice. 
Third  American,  from  the  Third  and  revised  Lon- 
don edition.  In  one  octavo  volume,  extra  cloth, 
of  528  pages.  $3  50. 

RIGBY  ON  THE  CONSTITUTIONAL  TREATMENT 
OF  FEMALE  DISEASES.  In  one  neat  royal  12mo. 
volume,  extra  cloth,  of  about  250  pages.  $1  00. 

DEWEES'S  TREATISE  ON  THE  DISEASES   OF  FE- 


MALES. With  illustrations.  Eleventh  Edition, 
with  the  Author's  last  improvements  and  correc 
tions.  In  one  octavo  volume  of  536  pages,  with 
plates,  extra  cloth,  $3  00. 

COLOMBAT  DE  L'ISERE  ON  THE  DISEASES  OF 
FEMALES.  Translated  by  C.  D.  MEIUS,  M.  D.  Se- 
cond edition.  In  one  vol.  Svo,  extra  cloth,  with 
numerous  wood-cuts,  pp.  720.  $3  75. 

BENXEfT'S  PRACTICAL  TREATISE  OX  INFLAM- 
MATION OF  THE  UTERUS,  ITS  CERVIX  AND 
APPENDAGES,  and  on  its  connection  with  Uteriue 
Disease.  Sixth  American,  from  the  fourth  and  re- 
vised English  edition.  1  vol.  Svo.,  of  about  ouO 
pages,  extra  cloth.  $3  75. 


II  I:\UY  C.  LEA'S  PUBLICATIONS — (Diseases  of  Women). 


23 


IJODKE  (HUfiH  L.).  M.D. 

•*  •*  EmerU'ui  Profcttor  u/  (Metric*,  tc.,  in  the  r*ivertity  nf  Ptnn»ylr<i 

ON   DISEASED  PErri.IAK  TO  WOMEN;  inefadi»fl 

of  the  I'ti-rurf.     With  original  illustrations.     Second  edition,  revised  and  enlarged.     In 
one  beautifully  printed  octavo  volume  of  531  pages,  extra  cloth.     $4  50.     (Now  Ready  ) 
In  the  preparation  of  this  edition  the  author  has  spared  no  pains  to  improve  it  with  the  results 
of  his  observation  and  study  during  the  interval  which  has  elapsed  since  the  first  appearance  of 
the  work.     Considerable  additions  have  thus  been  made  to  it,  which  have  been  partially  accom- 
modated by  an  enlargement  in  the  site  of  the  page,  to  avoid  increasing  unduly  the  bulk  of  the 
volume. 

uterus,  to  take  strong  ground  against  many  of  the 
highest  authorities  in  this  branch  of  medicine,  and 
the  arguments  which  he  offers  in  support  of  his  posi- 
tion are,  to  say  the  least,  well  put.  Numerous  wood- 
cuts adorn  this  portion  of  the  work,  and  add  incalcu- 
lably to  the  proper  appreciation  of  the  variously 
shaped  Instruments  referred  to  by  our  author.  As  a 
contribution  to  the  study  of  women's  diseaws.  it  i«of 
great  value,  and  is  abundantly  able  to  stand  on  its 
own  merits.— JV.  Y.  Medical  Record,  Sept.  15,  1808. 

In  this  point  of  view,  the  treatise  of  Professor 
Hodge  will  be  indispensable  to  every  student  in  its 
department.  The  large,  fair  type  and  general  perfec- 
tion of  workmanship  will  reader  it  doubly  welcome. 
— Paeijte  Mtd.  and  Surg.  Journal,  Oct.  1868. 


Paor.  W.  H.  BTroRn,  nf  the  Ruth  Xedtfal 

College,  Chicago. 
The  book  bears  the  impress  of  a  master  hand,  and 
mum,  .1  -v>r.  prove  acceptable  to  the  pro- 

IM  dUeaaes  of  women  Dr.  Hodge  has  e*tab- 
i  ftchool  of  treatment  that  ban  become  world- 
.  fame. 

'•!  ulife'n   work    i«   truly  an  original  one 


beginning  to  end.  eoawqnently 


race  I 


me  can  pe- 
new.    The 

lentofdis- 


believer  iu   :  y  of  Inflammations  of  the 


(CHARLES),  M.D. 


LECTURES  «)N  THE  DISEASES  OF  WOMEN.    Third  American, 

from  the  Third  London  edition.     In  one  neat  octavo  volume  of  about  550  pages,  extra 

cloth.     $3  75  ;  leather,  $4  75.     (Now  Rtady.) 

The  reputation  which  this  volume  has  acquired  as  a  standard  book  of  reference  in  its  depart- 
ment, render."  it  only  necessary  to  say  that  the  present  edition  has  received  a  careful  revision  at 
the  hands  of  the  author,  resulting  in  a  considerable  increase  of  size.  A  few  notices  of  previous 
editions  are  subjoined. 


.inner  of  the  author  is  excellent,  hi*  descrip- 
.   .»pliic  ami  perrpicuons,  and  his. treatment  up 

te,  and 

.  common  sense.  —  Chicago  lied. 
• 

unot  too  highly  recommend  this,  the  second 
edition  of  Or    UY-t  »  excellent  lecture*  on  the  din- 
ettes of  females.     We  know  of  no  other  book  on  this 
from  which  we  have  derived  ».--  much  pleasure 
•  *ge  given  evidence  of  the 
••.true.t.  anJ  diluent' iw.irctier  after  truth.    He 
i. e  mere  coin;  -  ideas,  but  his 

..i  often  years'  patient  invenllga- 

r  women's  disease* 
St.  Bnrt'i  •'    in. ••»••-  .1  ten.-h.-r,  !• 

I  earnest  in  his  language,  clear  and  com- 
•  iis,  and  logical  in  bin  de- 

•t,  Jan.  1862. 

the  author  thanks  for  the 

',  >iint  of  instruction  he  has  afford- d  u».     11'.- 
•'i»e  needs  no  eulogy  on  our  part.     His 
n  aud  truthful   j>  -.me  all 

'jr  them*elve*. — M'  ry.  Review. 

i"d  a  standard  work It 

beam  evidence  of  having  been  carefully  revised,  and 
Is  well  worthy  of  the  f»ine  it  has  already  obtained. 


i •>  an 

dnctl 

\\V  ft'ir 


|      As  a  writer.  Dr.  West  stands,  in  our  opinion,  se- 
I  cond  only  to  Watson,  the  "Macaulay  of  Medicine;" 
'  he  possesses  that  happy  faculty  of  clothing  instruc- 
tion  in  easy  garments;    combining    pleasure   with 
[  profit,  he  leads  bis  pupils,  in  spite  of  the  ancient  pro- 
verb, along  a  royal  road  to  learning.   His  work  is  one 
which  will  not  satisfy  the  extreme  on  either  side,  but 
It  i*  one  that  will  please  the  great  majority  who  are 
seeking  trnth,  and  one  that  will  convince  the  student 
that  he  has  committed  himself  to  a  candid,  safe,  and 
valuable  guide.— AT.  A.  Meil.-Chirurg  Review. 

We  must  now  conclude  this  hastily  written  sketch 
with  the  confident  assurance  to  oar  readers  that  the 
work  will  well  repay  perusal.  The  conscientious, 
paiustaking.  practical  physician  is  apparent  on  every 
page. — A'.  1".  Journal  of  Mtdtcin*. 

We  have  to  say  of  it,  briefly  and  deeidedly,  that  it 
Is  the  best  work  on  the  subject  In  any  language,  and 
that  it  stamps  Dr.  West  as  the  facile  princept  of 
British  obstetric  authors.— Edinburgh.  Jfed.  Journal. 

We  gladly  recommend  his  lectures  as  in  the  highest 
degree  instructive  to  all  who  are  interested  la  ob- 
stetric practice. — London.  Lancnt. 

We  know  of  no  treatUe  of  the  kind  so  complete, 
I  and  yet  so  compact. — Chicago  Jftd.  Journal. 


Tin:  KAMK 


AN   EN<>EIKY  INTO  THE   PATHOLOGICAL  IMPORTANCE  OF 
ULCERATION  OF  THK  OS  I'TKKI.     In  one  neat  octavo  volume,  extra  cloth.     $1  25. 


}TEIGS  (CHAH/.KS  />.),  M.  />.. 

•LU.  /,,,.<.  .!-ff>r*:"\ 

WOMAN:    HEi:  JHSKASKS    ANI>  Til  Kill    K  KM  K  I  >  I  KS.     A  Series 

of  Le-'tiire.j   to  his  C!H.--.<.      Fourth    ami    Itnjiroveil    e<lition.      In    one   l:ir^e  and  beautifully 
printed  octavo  volume  of  over  700  pages,  extra  cloth,  $5  00;  leather,  $6  00. 
p>Y  Till-:  M  My. 


ON  THE   NATURE,  SIGNS,  AND  TREATMENT  OE 

I'l  VKR.     In  a  Serie.<  of  Letters  n<Mre--e.J  t"  tlie  Students  of  his  Class.     In  one  handsome 
octavo  volume  of  3t!5  pages,  extra  cloth.     $2  00. 


J.\  !//•>•  }'.'.  M./>. 

CLINH'AL  LKCTTKES  ON  THE   DISEASES  OE  W(»MEN.    With 

numerous  illustrations.   In  one  octavo  volume  of  over  500  pages.    Second  edition,  preparing. 


HENRY  C.  LEA'S  PUBLICATIONS — (Midwifery). 


jffODGE  (HUGH  L.),  M.D., 

Emeritus  Professor  of  Midwifery,  &c.  in  the  University  of  Pennsylvania,  &c. 

THE   PRINCIPLES  AND   PRACTICE   OP   OBSTETRICS.     Illus- 

trated  with  large  lithographic  plates  containing  one  hundred  and  fifty-nine  figures  from 
original  photographs,  and  with  numerous  wood-cuts.  In  one  large  and  beautifully  printed 
quarto  volume  of  550  double-columned  pages,  strongly  bound  in  extra  cloth,  $14.  (Lately 
published. ) 


The  work  of  Dr.  Hodge  is  something  more  than  a 
simple  presentation  of  his  particular  views  in  the  de- 
partment of  Obstetrics;  it  is  something  more  than  an 
ordinary  treatise  on  midwifery ;  it  is,  in  fact,  a  cyclo- 
paedia of  midwifery.  He  has  aimed  to  embody  in  a 
single  volume  the  whole  science  and  art  of  Obstetrics. 
An  elaborate  text  is  combined  with  accurate  and  va- 
ried pictorial  illustrations,  so  that  no  fact  or  principle 
is  left  unstated  or  unexplained. — Am.  Med.  Times, 
Sept.  3,  1864. 

We  should  like  to  analyze  the  remainder  of  this 
excellent  work,  but  already  has  this  review  extended 
beyond  our  limited  space.  We  cannot  conclude  this 
notice  without  referring  to  the  excellent  finish  of  the 
work.  In  typography  it  is  not  to  he  excelled;  the 
paper  is  superior  to  what  is  usually  afforded  by  our 
American  cousins,  quite  equal  to  the  best  of  English 
books.  The  engravings  and  lithographs  are  most 
beautifully  executed.  The  work  recommends  itself 
for  its  originality,  and  is  in  every  way  a  most  valu- 
able addition  to  those  on  the  subject  of  obstetrics. — 
Canada  Med.  Journal,  Oct.  1864. 

It  is  very  large,  profusely  and  elegantly  illustrated, 
and  is  fitted  to  take  its  place  near  the  works  of  great 
obstetricians.  Of  the  American  works  on  the  subject 
it  is  decidedly  the  best.—  Edinb.  Med.  Jour.,  Dec.  '64. 

#**  Specimens  of  the  plates  and  letter-press 
on  receipt  of  six  cents  in  postage  stamps. 


We  have  examined  Professor  Hodge's  work  with 
great  satisfaction;  every  topic  is  elaborated  most 
fully.  The  views  of  the  author  are  comprehensive, 
and  concisely  stated.  The  rules  of  practice  are  judi- 
cious, and  will  enable  the  practitioner  to  meet  every 
emergency  of  obstetric  complication  with  confidence. 
— Chicago  Med.  Journal,  Aug.  18(34. 

More  time  than  we  have  had  at  our  disposal  since 
we  received  the  great  work  of  Dr.  Hodge  is  necessary 
to  do  it  justice.  It  is  undoubtedly  by  far  the  most 
original,  complete,  and  carefully  composed  treatise 
on  the  principles  and  practice  of  Obstetrics  which  has 
ever  been  issued  from  the  American  press. — Paciji* 
Med.  and  Surg.  Journal,  July,  1861. 

We  have  read  Dr.  Hodge's  book  with  great  plea- 
sure, and  have  much  satisfaction  in  expressing  our 
commendation  of  it  as  a  whole.  It  is  certainly  highly 
instructive,  and  in  the  main,  we  believe,  correct.  "The 
great  attention  which  the  author  has  devoted  to  the 
mechanism  of  parturition,  taken  along  with  the  con- 
clusions at  which  he  has  arrived,  point,  we  think, 
conclusively  to  the  fact  that,  in  Britain  at  least,  the 
doctrines  of  Naegele  have  been  too  blindly  received. 
— Glasgow  Med.  Journal,  Oct.  1864. 

will  be  forwarded  to  any  address,  free  by  mail, 


BANNER  (THOMAS  H.),  M.  D., 


ON  THE  SIGNS  AND  DISEASES  OF  PREGNANCY.     First  American 

from  the  Second  and  Enlarged  English  Edition.     With  four  colored  plates  and  illustrations 
on  wood.     In  one  handsome  octavo  volume  of  about  500  pages,  extra  cloth,  $4  25.     (Just 
Issued.) 
The  very  thorough  revision  the  work  has  undergone  |  state  even,  acceptable  to  the  profession.     We  record - 


has  added  greatly  to  its  practical  value,  and  increased 
materially  its  efficiency  as  a  guide  to  the  student  and 
to  the  young  practitioner.  —  Am.  Journ.  Med.  Sci., 
April,  1S68. 

With  the  immense  variety  of  subjects  treated  of 
and  the  ground  which  they  are  made  to  cover,  the  im- 
possibiliiy  of  giving  an  extended  review  of  this  truly 


single  fault  to  find  with  it,  and  most  heartily  com- 
mend it  to  the  careful  study  of  every  physician  who 
would  not  only  always  be  sure  of  his  diagnosis  of 
pregnancy,  but  always  ready  to  treat  all  the  nume- 
rous ailments  that  are,  unfortunately  for  the  civilized 
women  of  to-day,  so  commonly  associated  with  the 
function.—  N.  ¥.  Med.  Record,  March  16,  1868. 


our  readers  to  the  volume  produced  by  Dr.  Tanner, 
the  second  edition  of  a  work  that  was,  in  its  original 


mend  obstetrical  students,  young  and  old,  to  have 
this  volume  in  their  collections.  It  contains  not  only 
a  fair  statement  of  the  signs,  symptoms,  and  diseases 
of  pregnancy,  but  comprises  in  addition  much  inter- 
esting relative  matter  that  is  not  to  be  found  in  any 
other  work  that  we  can  name. — Edinburgh  Mtd. 
Journal,  Jan.  1868. 

In  its  treatment  of  the  signs  and  diseases  of  preg- 
nancy it  is  the  most  complete  book  we  know  of, 
abounding  on  every  page  with  matter  valuable  to  the 
general  practitioner. — Cincinnati  Med.  Repertory, 
March,  1868. 

This  is  a  most  excellent  work,  and  should  be  on  the 
table  or  in  the  library  of  every  practitioner. — Hum- 
boldt  Med.  Archives,  Feb.  1868. 

A  valuable  compendium,  enriched  by  his  own  la- 
bors, of  all  that  is  known  on  the  signs  and  diseases  of 
pregnancy. — St.  Louis  Med.  Reporter,  Feb.  lu,  1S6S. 


MONTGOMERY  (w.  p.),  M.D., 

Professor  of  Midwifery  in  the  King's  and  Queen's  College  of  Physicians  in  Ireland. 

AN  EXPOSITION  OF  THE  SIGNS  AND  SYMPTOMS  OF  PREG- 

NANCY.  With  some  other  Papers  on  Subjects  connected  with  Midwifery.  From  the  second 
and  enlarged  English  edition.  With  two  exquisite  colored  plates,  and  numerous  wood-cuts 
In  one  very  handsome  octavo  volume  of  nearly  600  pages,  extra  cloth.  $3  75. 


(HENRY],  M.D., 

Professor  of  Obstetrics  and  Diseases  of  Women  and  Children  in  the  University  of  Louisville. 

PRINCIPLES  AND  PRACTICE  OF  OBSTETRICS,  &c.;  including 

the  Treatment  of  Chronic  Inflammation  of  the  Cervix  and  Body  of  the  Uterus  considered 
as  a  frequent  cause  of  Abortion.  With  about  one  hundred  illustrations  on  wood.  In  one 
very  handsome  octavo  voluinfe  of  over  600  pages,  extra  cloth.  $3  75. 


RIGBT'S  SYSTEM  OF  MIDWIFERY.  With  Notes 
and  Additional  Illustrations.  Second  American, 
edition.  One  volume  octavo,  extra  cloth,  422  pages. 
$250. 


DEWEES'S  COMPREHENSIVE  SYSTEM  OF  MID- 
WIFERY. Twelfth  edition,  with  the  author's  last 
improvements  and  corrections.  In  one  octavo  vol- 
ume, extra  cloth,  of  600  pages.  $3  50. 


HENRY  C.  LEA'S  PUBLICATIONS — (Midwifery). 


25 


\CIIARLES  D.),  M.D., 

!.<>t.  l,j  r,  -t«trio9,  *c  ,  in  Out  Jeferton,  Medical  OoUtyt,  PhilatUlphia, 

OIISTKTKICS:    Till:    SCIKNCK    AND    T1IK    A 11T.      Fifth    edition, 

revised.     With  one  hundred  and  thirty  illustrations.     In  one  beautifully  printed  octavo 
volume  of  760  large  pages.      F.xtra  cloth,  $5  50;  leather,  $6  60.      (Just  Itintti.) 

The  original  edition  Is  already  so  extensively  and  •  practitioner.    The  rapidity  with  whlcb  the  very  large 
... IKIWU  to  the  profeiiMon  that  no   recom-    editions  have  been  exhausted  is  the  beet  test  of  its 
endatlou   i-  n»ce»«ary;  it  is  sufficient   to  say,  the     true  merit      Besides,  it  is  the  prodnctlon  of  ao  Ame- 
•    much  extended,  improved,     rican  wAo  has  probably  had  more  experience  in  this 
Wlul-t  the  area  i  practical  talents  and     I  Tan  eh  than  any  other  living  practitioner  of  the  coun- 
try.— St.  L<>  nig  Med.  and  Surg.  Journal,  Sept.  1867. 
He  has  also  carefully  endeavored  to  be  minute  and 


••  author  render  i: 
>u  to  the  practitioner,  it  i- 
itute  a  most  eligible  and  e\ 


-.  lent.—  Southern  Med.  and  Surg. 
Journal,  .I'i!y, 

-indent  that  onr  author  has  more  par- 

—  .-,1   himself;  hut  to   the  practitioner 

tble  as  a  book 

N  >  work  that  we  have  met  with   HO 

verything  that  falls  to  the  lot  of 

:r  to  perform.     Every  detail,  no  matter 

how  ininme    ,.r    how  trivial,  him   found   a   place.  — 

al  Journal,  July,  1867. 

This  very  excellent  work  on  the  science  and  art  of 
obstetrics  shonld  be  in  the  hands  of  every  student  and 


clear  in  his  details,  with  as  little  reiteration  a«  pomi- 
ble,  and  beautifully  combines  the  relations  of  science 
to  art,  as  far  as  the  different  classifications  will  admit. 
— Detroit  Review  of  Med.  and  Pharm.,  Ang.  1867. 

We  now  take  leave  of  Dr.  Melgs.  There  are  many 
other  and  interesting  points  in  bis  book  on  which  we 
would  fain  dwell,  but  are  constrained  to  bring  onr  ob- 
«ei  vaiiou*  to  a  clone.  We  again  heartily  express  oar 
approbation  of  the  labors  of  Dr.  Meiga,  extendingover 
many  years,  and  culminating  in  the  work  before  us, 
full  of  practical  hints  for  the  inexperienced,  anil  •  v.-u 
i'..r  tho«>  whose  experience  has  been  considerable. — 
Gflasguio  Medical  Journal,  Sept.  1S67. 


DAMSBOTHAM  (FRAXCIS  If.),  M.D. 
.1 1 

Till:    riUNCIPLES   AND    PRACTICE   OF    OBSTETRIC    MEPI- 

l  INK  AND  SURGERY,  in  reference  to  the  Process  of  Parturition.  A  new  and  enlarged 
eiliti.'n.  thoroughly  revised  by  the  autliiir.  With  additions  by  W.  V.  KEATING,  M.  D., 
Professor  of  Obstetrics,  Ac.,  in  the  Jefferson  Medical  College,  Philadelphia.  In  one  large 
and  handsome  imperial  octavo  volume  of  650  pages,  strongly  bound  in  leather,  with  raised 
b:inds;  with  sixty-tour  beautiful  plates,  and  numerous  wood-cuts  in  the  text,  containing  in 
all  nearly  200  large  and  beautiful  figures.  $7  00. 

We  will  only  add  that  the  student  will  learn  from  To  the  physician's  library  it  is  indispensable,  while 

it  all  he  need  to  know,  and  the  practitioner  will  find  to  the  student,  as  a  text-book,  from  which  to  extract 

it,  ax  a  bonk  of  reference,  surpassed  by  none  other. —  the  material  for  laying  the  foundation  of  an  education 

•>])?..  on  obstetrical  science,  it  baa  no  superior. — Ohio  Med. 

The  character  and   merlin  of  Dr.   Ramsbotham's  i  atld  Surff-  Journal. 

work  .:                      .iown  and  thoroughly  e»tahlUhed,  When  we  call  to  mind  the  toil  we  underwent  in 

-  try  and  praise  Mipertluous.  acquiring  a  knowledge  of  this  subject,  we  cannot  bnt 

•  •a-,  which  are  numerous  aud  accurate,  envy  the  student  of  the  present  day  the  aid  which 

:  in  the  highest  style  of  art.     We  cannot  this  work  will  afford  him. — Am.  Jour,  of  the  Med. 

>d  the  work  to  our  readers. — tit.  ti'-.lencet. 
j.  Juu.riH.il. 


ftHURCHILL  (Fl.KKTWnon),  M.  D.,  M.R.I.  A. 
ON  THE  THE<T1JY  AND   PRACTICE  OF    M  I  DWI  FEU  V.     A  new 

Amerio:in  from  the  fourth  revised  :ind  enlarged  London  edition.      With  notes  mid  additions 
\-\  \>    Fi:  .  K,  M.  D  ,  author  ot  u  ••  l'r:ictii  al  Treatise  on  the  Diseases  of  Chil- 

dren." Ac.     With  on* bandied  and  ninety-four  illii.'trntions.     In  mie  very  handsome  octavo 
volume  of  nearly  Tun  large  pages.     Extra  cloth,  $4  00;  leather,  $5  00. 

In  adapting  thi»  standard  Iiivorite  to  the  friints  ol'the  profession  in  the  United  States,  the  editor 

>ed  t,,  insert  .•MTythin^  that  his  f.xiierience  IIIIH  shown  him  wmild  !.*•  desirable  for  the 

Ani'iii-an  -;u  i. -ni.  including  a  lar^e  niiiul.er  <>l  illu-i  i  at  mns.      With  the  sanction  of  the  author. 

he  ban  nd.led,  in  the  fnnu  ot   an  ii|i|wiidix,  some  .'lupters   from  a  little  "  .Manual   for  Midwives  and 

.1  l«y  I"r.  Cliun-liill,  believing  that   the  details  there   jire^enti-d   can   hardly 

tail  to  prove  ••:  advantage  to  the  junior  practitioner.  The  result  of  all  tin  se  additions  is  that  the 
work  now  contains  fully  one-half  more  matter  than  the  last  American  edition,  with  nearly  one- 
half  in-. re  illu-trations;  so  tlmt,  notwithstanding  the  use  of  a  smaller  type,  the  volume  contains 
mn."-t  two  hundred  pages  more  than  before. 


• 


!-r  the  work    Mill    i 
tide   tlmu   ever  ;  and  with 
lirh   th-     ' 
t'lmrrhill,  we  c»n   coniniund    !!   K 


profension  with  great  cordiality  and  p  • 

Few  work*  on  this  branch  of  medical  uriencn  ar" 
eijMal  t..  it.  certainly  none  «ixcel  it,  wh'-t!ier  K. 

:  .  and  in  one  re*|>eet  it  i>  .uperior 

to  all   oilier-,  vu..  In   its  statiMtical  iiifornmtion,  and 


jectsin  all  ti. 
even  mure  neoMM 
were  cither  of  the  ( 

.V.  1 1 

. 


dded  which  could  be  well  dispensed  with. 

lullou  of  the   tulile  of  >  ws  how 

y  :!o>  aim  ,ud,  and 

vxt  to  prexent  the   sub- 


v -..rk  for  .  gathered  from  every  source.— 
it,  ,.r  lecturer,  all  of  whom  will 

Bud  in  it  the  information  which  they  are  seeking.— 
Brit.  AM.  Journal. 


render  I 

ill    than 

of  their 

•••.  ilh  which  we 

v  with  this,  in 

iterial    which    '< 

i  Mxt.  an<t  Sury. 


The  pre«ent  treati««  is  very  much   enlarged   and 
»  previous  editions  but  nothing 


Journal. 

Tin-re  Is  no  better  tnxt-book  for  students,  or  work 

•iij  ktody  for  the  jiract'-inc  pi 
than  this.     It  xhould  adorn  and  enrich  every  medical 
library. — CMcugn  Med.  Journal. 


26 


HENRY  C.  LEA'S  PUBLICATIONS — (Surgery). 


SI  ROSS  (SAMUEL  D.},  M.D., 

Professor  of  Surgery  in  the  Jefferson  Medical  College  of  Philadelphia. 

A  SYSTEM  OF  SURGERY:    Pathological,  Diagnostic,  Therapeutic, 

and  Operative.  Illustrated  by  upwards  of  Thirteen  Hundred  Engravings.  Fourth  edition, 
carefully  revised,  and  improved.  In  two  large  and  beautifully  printed  royal  octavo  volumes 
of  2200  pages,  strongly  bound  in  leather,  with  raised  bands.  $15  00. 

The  continued  favor,  shown  by  the  exhaustion  of  successive  large  editions  of  this  great  work, 
proves  that  it  has  successfully  supplied  a  viant  felt  by  American  practitioners  and  students.  Though 
but  little  over  six  years  have  elapsed  since  its  first  publication,  it  has  already  reached  its  fourth 
edition,  while  the  care  of  the  author  in  its  revision  and  correction  has  kept  it  in  a  constantly  im- 
proved shape.  By  the  use  of  a  close,  though  very  legible  type,  an  unusually  large  amount  of 
matter  is  condensed  in  its  pages,  the  two  volumes  containing  as  much  as  four  or  five  ordinary 
octavos.  This,  combined  with  the  most  careful  mechanical  execution,  and  its  very  durable  binding, 
renders  it  one  of  the  cheapest  works  accessible  to  the  profession.  Every  subject  properly  belonging 
to  the  domain  of  surgery  is  treated  in  detail,  so  that  the  student  who  possesses  this  work  may  be 
said  to  have  in  it  a  surgical  library. 


It  must  long  remain  the  most  comprehensive  work 
on  this  important  part  of  medicine. — Boston  Medical 
and  Surgical  Journal,  March  23,  1865. 

We  have  compared  it  with  most  of  our  standard 
works,  such  as  those  of  Erichsen,  Miller,  Fergusson, 
Syme,  and  others,  and  we  must,  in  justice  to  our 
author,  award  it  the  pre-eminence.  As  a  work,  com- 
plete in  almost  every  detail,  no  matter  how  minute 
or  trifling,  and  embracing  every  subject  known  in 
the  principles  and  practice  of  surgery,  we  believe  it 
stands  without  a  rival.  Dr.  Gross,  in  his  preface,  re- 
marks "my  aim  has  been  to  embrace  the  whole  do- 
main of  surgery,  and  to  allot  to  every  subject  its 
legitimate  claim  to  notice ;"  and,  we  assure  our 
readers,  toe  has  kept  his  word.  It  is  a  work  which 
we  can  most  confidently  recommend  to  our  brethren, 
for  its  utility  is  becoming  the  more  evident  the  longer 
it  is  upon  the  shelves  of  our  library. — Canada  Med. 
Journal,  September,  1865. 

The  first  two  editions  of  Professor  Gross'  System  of 
Surgery  are  so  well  known  to  the  profession,  and  so 
highly  prized,  that  it  would  be  idle  for  us  to  speak  in 
praise  of  this  work.  —  Chicago  Medical  Journal, 
September,  1&65. 

We  gladly  indorse  the  favorable  recommendation 
of  the  work,  both  as  regards  matter  and  style,  which 
we  made  when  noticing  its  first  appearance. — British 
and  Foreign  Medico-Chirurgical  Review,  Oct.  1865. 

The  most  complete  work  that  has  yet  issued  from 
the  press  on  the  science  and  practice  of  surgery. — 
London  Lancet. 

This  system  of  surgery  is,  w«  predict,  destined  to 
take  a  commanding  position  in  our  surgical  litera- 
ture, and  be  the  crowning  glory  of  the  author's  well 
earned  fame.  As  an  authority  on  general  surgical 
subjects,  this  work  is  long  to  occupy  a  pre-eminent 
place,  not  only  at  home,  but  abroad.  We  have  no 
hesitation  in  pronouncing  it  without  a  rival  in  our 
language,  and  equal  to  the  best  systems  of  surgery  in 
any  language. — N.  T.  Med.  Journal. 

Not  only  by  far  the  best  text-book  on  the  subject, 
as  a  whole,  within  the  reach  of  American  students, 
but  one  which  will  be  much  more  than  ever  likely 
to  be  resorted  to  and  regarded  as  a  high  authority 
abroad. — Am.  Journal  Med.  Sciences,  Jan.  1865. 

The  work  contains  everything,  minor  and  major, 
•perative  and  diagnostic,  including  mensuration  and 
examination,  venereal  diseases,  and  uterine  manipu- 
lations and  operations.  It  is  a  complete  Thesaurus 
«f  modern  surgery,  where  the  student  and  practi- 


tioner shall  not  seek  in  vain  for  what  they  desire. — 
San  Francisco  Med.  Press,  Jan.  Isti.). 

Open  it  where  we  may,  we  find  sound  practical  in- 
formation ccfriveyed  in  plain  language.  This  book  is 
no  mere  provincial  or  even  national  system  of  sur- 
gery, but  a  work  which,  while  very  largely  indebted 
to  the  past,  has  a  strong  claim  on  the  gratitude  of  the 
future  of  surgical  science. — Edinburgh  Med.  Journal, 
Jan.  1865. 

A  glance  at  the  work  is  sufficient  to  show  that  the 
author  and  publisher  have  spared  no  labor  in  making 
it  the  most  complete  "System  of  Surgery"  ever  pub- 
lished in  any  country. — St.  Louis  Med.  and  Surg. 
Journal,  April,  1865. 

The  third  opportunity  is  now  offered  during  our 
editorial  life  to  review,  or  rather  to  indorse  and  re- 
commend this  great  American  work  on  Surgery. 
Upon  this  last  edition  a  great  amount  of  labor  lias 
been  expended,  though  to  all  others  except  the  authoi 
the  work  was  regarded  in  its  previous  editions  as  so 
full  and  complete  as  to  be  hardly  capable  of  improve- 
ment. Every  chapter  has  been  revised ;  the  text  aug- 
mented by  nearly  two  hundred  pages,  and  a  con- 
siderable number  of  wood-cuts  have  been  introduced. 
Many  portions  have"  been  entirely  re-written,  and  the 
additions  made  to  the  text  are  principally  of  a  prac 
tical  character.  This  comprehensive  treatise  upon 
surgery  has  undergone  revisions  and  enlargements, 
keeping  pace  with  the  progress  of  the  art  and  science 
of  snrgery,  so  that  whoever  is  in  possession  of  this 
work  may  consult  its  pages  upon  any  topic  embraced 
within  the  scope  of  its  department,  and  rest  satisfied 
that  its  teaching  is  fully  up  to  the  present  standard 
of  surgical  knowledge.  It  is  also  so  comprehensive 
that  it  may  truthfully  be  said  to  embrace  all  that  is 
actually  known,  that  is  really  of  any  value  in  the 
diagnosis  and  treatment,  of  surgical  diseases  and  acci- 
dents. Wherever  illustration  will  add  clearness  to  the 
subject,  or  make  better  or  more  lasting  impression,  it 
is  not  wanting;  in  this  respect  the  work  is  eminently 
superior. — Buffalo  Med.  Journal,  Dec.  1S64. 

A  system  of  surgery  which  we  think  unrivalled  in 
our  language,  and  which  will  indelibly  associate  hig 
name  with  surgical  science.  And  what,  in  our  opin- 
ion, enhances  the  value  of  the  work  is  that,  while  the 
practising  surgeon  will  find  all  that  he  requires  in  it, 
it  is  at  the  same  time  one  of  the  most  valuable  trea- 
tises which  can  be  put  into  the  hands  of  the  student 
seeking  to  know  the  principles  and  practice  of  this 
branch  of  the  profession  which  he  designs  subse- 
quently to  follow. — The  Brit.  Am.  Journ.,  Mouirtal. 


J)Y  THE  SAME  AUTHOR. 

A  PRACTICAL    TREATISE    ON   THE    DISEASES,   INJURIES, 

AND  MALFORMATIONS  OF  THE  URINARY  BLADDER,  THE  PROSTATE  GLAND, 
AND  THE  URETHRA.  Second  edition,  revised  and  much  enlarged,  with  one  hundred 
and  eighty-four  illustrations.  In  one  large  and  very  handsome  octavo  volume,  of  over  nine 
hundred  pages,  extra  cloth.  $4  00. 


Whoever  will  peruse  the  vast  amount  of  valuable 
practical  information  it  contains  will,  we  think,  agree 
with  us,  that  there  is  no  work  in  the  English  lan- 


guage which  can  make  any  just  pretensions  to  be  its 
equal. — N.  T.  Journal  of  Medicine. 


[)Y  THE  SAME  AUTHOR. 

A  PRACTICAL   TREATISE    ON    FOREIGN    BODIES   IN  THE 

AIR-PASSAGES.       In   one  handsome   octavo   volume,    extra  cloth,    with  illustrations, 
pp.  468.     $2  75. 


UENBY  C.  LEA'S  PUBLICATIONS — (Surgery). 


27 


//•/.•/••//>•/•: .v  JOHN 

•*-'  I',-'>ff.»»ar  of  Surgery  In  University  College, 

TIIK  SCIENCE  AND  ART  OF  SURGERY;  l-in- a  Treatise  on  Sur- 

Injuries.  Disease?,  and  Operations.  New  and  imjiroved  American,  from  the  Second 
enlarged  and  carefully  revised  London  edition.  Illustrated  with  over  four  hundred  wood 
engravings.  In  one  large  and  handsome  octavo  volume  of  1000  closely  printed  pages;  extra 
cloth,  $6 ;  leather,  raised  bands,  $7. 

We  *re  bound  to  state,  and  we  do  BO  without  with-  »»  one  of  the  very  best,  If  not  the  best  text-book  of 

Iraw  invidion*  compari-on*.  that  Hie  work  of  surgery  with  which  we  were  acquainted,  permits  ns 

Mr.  F.rrt, -••[],  in   :                       -.  sarpaRnes  any  that  t<>  give  it  but  a  passing  notice  totally  unworthy  of  itt 

ha«  preceded  it.     Mr    Krirhwn's  is  a  practical  work,  merits.     It  may  be  confidently  asserted,  that  DO  work 

u<  a  doe  proportion  of  the  "Science  and  An  on  the  science  and  art  of  surgery  has  erer  received 

II  ivii..-  .It-rived  no  little  instruction  more  uniTersal  commendation  or  occupied  a  higher 

from  it,  iu  many  important  branches  of  surgery,  we  position  as  a  general  text-book  on  surgery,  than  this 

can  have  no  heMtation  in  recommending  it  a«  a  valu-  treatUeof  Professor  Krichsen. — Savannah  Journal  of 

able  book  alike  to  the  practitioner  and  the  student.  M><licine. 

—  Dublin  Quarterly.  jn  fuiaeM  of  practical  detail  arid  perspicuity  of 

Given  a  rery  admirable,  practical  view  of  the  net-  style,  convenience  of  arrangement  and  conudness  of 

ence  and  art  of  surgery. — Edinburgh  Med.  and  Surg.  discrimination,  as  well  as  fairness  and  completeness 

j.,«r  '  !  -'-uintion,  it  is  better  sailed  to  the  wants  of  both 

-commend  It  as  the  best  compendium  of  snr-  "Indent  and  pnictitioner  than  any  of  lu  predecessors. 

gery  in  our  language.-Lon*m  Lancet.  ~A  "»•  Journal  of  Med.  Science*. 

It  is,  we  think,  the  most  Talnable  practical  work  After  c»refl11  »»d  fre'iaent  perusals  of  Erichsea'. 

-»ry  in  existence,  both  for  young  and  old  prac-  ".ur«er/.'.wVi.r*      .1     "  f?ll,y  V  «*"»•  "^AA""^' 

-.^hville  Med.  and  K«rg.  J-urnal.  "    "•    ,The  a"^or  •  ^  >»  ewiuently  d.dacUc, 

and   eaaractafind   '•>'  H  in..-i  admirable  directness, 

The  limited  time  we  have  to  review  this  improved  clearness,  and  compactness. — Ohio  Med.  and  Surg. 

•  fa  work,  the  first  issue  of  which  we  prized  Jnurnal. 


nr   THE  SAME  ACTIf>K.      (Rtndy  in  June.) 

OX    RAILWAY.    ANI>    OTHER    INJURIES   OF    THE    NERVOUS 

SYSTEM.     In  small  octavo  volume.     Extra  cloth,  $1  00. 


•  Ic'ime  thin  a»  perha|>*  thi^  ni"-t  practically 
ueu   for   many  a  day. — Medical 
. 
It  will  serve  a«  a  most  useful  and  trustworthy  guide 


to  the  profession  In  general,  many  of  whom  may  be 
consulted  in  such  cases;  and  it  will,  no  doubt,  take 
its  place  as  a  text-book  on  the  subject  of  which  it 
treat*.—  Medical  Prett. 


M 


Il.LKR    (JAMI' 

fsif>  /Y"/Wv"r  •-!'  Sirrgenj  in  the.  University  of  Edinburgh,  Ac. 

PRINCIPLES  OF  SURGERY.     Fourth  American,  from  the  third  and 

rr\  !-<••!  1-Minburgh  e<liti«>n.  In  one  large  and  very  beautiful  volume  of  700  pages,  with 
two  hundred  and  forty  illustrations  on  wood,  extra  cloth.  $3  75. 

J]Y  THE  SAME  AUTHOR.  

TIIK    PRATTICE   OF   SURGERY.     Fourth  American,  from  the  last 

Edinburgh  edition.  Revised  by  the  Americtin  editor.  Illustrated  by  three  hundred  and 
sixty-four  engravings  on  wood.  In  one  large  octavo  volume  of  nearly  700  pages,  extra 
cloth.  $3  75. 

.  tluit  ttv»  volumes  have  ever  mailf  M.I  I  »ri|iiir>-il.    The  author  is  an  eminently  sensible,  prac- 
profound  »n  impf  -.hort  a  time   a*  tlie  |  tical,  and  well-Informed   nmn,   who    knuwx  exactly 

nn. I  the   "  I'ruclire"  of  Snrt'i-ry  l>y  Mr.      n  K:ir  |l(.  IM  talking  about  and  exactly  how  to  talk  it. — 
r  no  richly  merited  the  reputation  they  have  |  A'"i/-/«-Ay  Medical  Recorder. 


PI l!ll IK  f  \\'ILU.\  Vi.  F.  R.S.  PI.. 
f  .t 

TIIK   rillNCHM.KS   AND   PRACTICE  <>F  STIICKRY.     K.I  it  IM!  by 

.J.Mix  NKII.I.,  M.  I'.,  Pruff-r-or  nf  Surpery  in  th»-  Penna.  Medical  College,  Surgeon  to  the 
IVnn-yKaiiia  lf>c|>ital,  Ac.  In  one  very  handdouie  octavo  volume  of  TbO  pages,  with  31tt 
illu.xtrationo,  extra  cloth.  $'•'•  ~'t. 


G 


w.}.  M.D. 


ON  BANDAGING  ANDOTHKR  OPERATIONS  OF  MINOR  SUR- 

:i|'t<Ton  Military  Surgery.    One  handsome  royal 
i  cuts.      Kitra  cloth,  $1  75. 
•  i;.,::y  r..rn         -  am-  as  one  which 

the  medical  student  «hon:.'  iy;  and 

toth»*nrgeon  In  practice  it  mnM  pr..v..  it»>lf  m-trnrt- 
M.my  points  which  he  may  have  forgotten. — 

Brit.  Am.  Journal,  May.  Isvttli. 


U  K IIV.     New  edition,  with  an  a 
1'Jtiio.  volume,  of  nearly  400  page;,  with 
Exceedingly  convenient  and  valuable  In  all   H..-MI- 
lofession. — Oiicayi  .!/••/. 

The  very  best  manual  of  Minor  Surgery  we  have 
IH»'II. — Ltuffulo  Medicul  Journal. 


MALOAIGXE'8  OPERATIVE  8UROKRT.     With  nn-  I  SK  ;  r.RT.    In  •>•«  Terr  hand- 

nieron*  lllii"ir.«tion«  on  W..IH!.     ID  one  hand«»me         som»  octavo  volume,  extra  cloth,  of  over  650  pig**, 
octavo  volume,  extra  cloth,  of  nearly  600pp.    *2  30.  |      with  about  100  wood-cats.    $3  iS. 


HENRY  C.  LEA'S  PUBLICATIONS — (Surgery). 


TJRUITT  (ROBERT),  M.R.C.S.,  frc. 


THE  PRINCIPLES  AND  PRACTICE  OF  MODERN  SURGERY. 

A  new  and  revised  American,  from  the  eighth  enlarged  and  improved  London  edition.  Illus- 
trated with  four  hundred  and  thirty -two  wood-engravings.  In  one  very  handsome  octavo 
volume,  of  nearly  700  large  and  closely  printed  pages.  Extra  cloth,  $4  00;  leather,  $5  00. 

Besides  the  careful  revision  of  the  author,  this  work  has  had  the  advantage  of  very  thorough 
editing  on  the  part  of  a  competent  surgeon  to  adapt  it  more  completely  to  the  wants  of  the  Ameri- 
can student  and  practitioner.  Many  illustrations  have  been  introduced,  and  every  care  has  been 
taken  to  render  the  mechanical  execution  unexceptionable.  At  the  very  low  price  affixed,  it  will 
therefore  be  found  one  of  the  most  attractive  and  useful  volumes  accessible  to  the  American 
practitioner. 


All  that  the  surgical  student  or  practitioner  could 
desire. — Dublin  Quarterly  Journal. 

It  is  a  most  admirable  book.  We  do  not  know 
when  we  have  examined  one  with  more  pleasure.— 
Boston  lied,  and  Surg.  Journal. 

In  Mr.  Druitt's  book,  though  containing  only  some 
seven  hundred  pages,  both  the  principles  and  the 
practice  of  surgery  are  treated,  and  so  clearly  and 
perspicuously,  as  to  elucidate  every  important  topic. 
The  fact  that  twelve  editions  have  already  been  called 
for,  in  these  days  of  active  competition,  would  of 
itself  show  it  to  possess  marked  superiority.  We 
have  examined  the  book  most  thoroughly,  and  can 
say  that  this  success  is  well  merited.  His  book, 
moreover,  possesses  the  inestimable  advantages  of 
having  the  subjects  perfectly  well  arranged  and  clas- 
sified, and  of  being  written  in  a  style  at  once  clear 
and  succinct. — Am.  Journal  of  Med.  Sciences. 

Whether  we  view  Druitt's  Surgery  as  a  guide  to 
operative  procedures,  or  as  representing  the  latest 


theoretical  surgical  opinions,  no  work  that  we  are  at 
present  acquainted  with  can  at  all  compare  \rith  it. 
It  is  a  compendium  of  surgical  theory  (if  we  may  use 
the  word)  and  practice  in  itself,  and  well  deserve* 
the  estimate  placed  upon  it. — Brit.  Am.  Journal. 

Thus  enlarged  and  improved,  it  will  continue  to 
rank  among  onr  best  text-books  on  elementary  sur- 
gery.— Columbus  Rev.  of  Med.  and  Surg. 

We  must  close  this  brief  notice  of  an  admirable 
work  by  recommending  it  to  the  earnest  attention  of 
every  medical  student. — Charleston  Medical  Journal 
and  Review. 

A  text-book  which  the  general  voice  of  the  profes- 
sion in  both  England  and  America  has  commended  at- 
one of  the  most  admirable  "manuals,"  or,  "vade 
mecum,"  as  its  English  title  runs,  which  can  be 
placed  in  the  hands  of  the  student.  The  merits  of 
Druitt's  Surgery  are  too  well  known  to  every  one  to 
need  any  further  eulogium  from  us. — Nashville  Med. 
'Journal. 


TJAMILTON  (FRANK  H.),  M.D., 

Professor  of  Fractures  and  Dislocations,  &c.  in  Bellevue  Hasp.  3fed.  College,  AVtc  York. 

A  PRACTICAL  TREATISE   OX  FRACTURES  AND   DISLOCA- 

TIONS.     Third  edition,  thoroughly  revised.     In  one  large  and  handsome  octavo  volume 
of  777  pages,  with  294  illustrations,  extra  cloth,  $5  75.     (Jutt  Issued.) 

The  demand  which  has  so  speedily  exhausted  two  large  editions  of  this  work  shows  that  the 
author  has  succeeded  in  supplying  a  want,  felt  by  the  profession  at  large,  of  an  exhaustive  treatise 
on  a  frequent  and  troublesome  class  of  accidents.  The  unanimous  voice  of  the  profession,  abroad 
as  well  as  at  home,  has  pronounced  it  the  most  complete  work  to  which  the  surgeon  can  refer  for 
information  respecting  all  details  of  the  subject.  In  the  preparation  of  this  new  edition,  the 
author  has  sedulously  endeavored  to  render  it  worthy  a  continuance  of  the  favor  which  has  been 
accorded  to  it,  and  the  experience  of  the  recent  war  has  afforded  a  large  amount  of  material  which 
he  has  sought  to  turn  to  the  best  practical  account. 


In  fulness  of  detail,  simplicity  of  arrangement,  and 
accuracy  of  description,  this  work  stands  unrivalled. 
So  far  as  we  know,  no  other  work  on  the  subject  in 
the  English  language  can  be  compared  with  it.  While 
congratulating  our  trans-Atlantic  brethren  on  the 
European  reputation  which  Dr.  Hamilton,  along  with 
many  other  American  surgeons,  has  attained,  we  also 
may  be  proud  that,  in  the  mother  tongue,  a  classical 
work  has  been  produced  which  need  not  fear  compa- 
rison with  the  standard  treatises  of  any  other  nation. 
—Edinburgh  Med.  Journal,  Dec.  1866. 

The  credit  of  giving  to  the  profession  the  only  com 
plete  practical  treatise  on  fractures  and  dislocations 
in  our  language  during  the  present  ceiitury,  belongs 
to  the  author  of  the  work  before  us,  a  distinguished 


American  professor  of  surgery;  and  his  book  adds 
one  more  to  the  list  of  excellent  practical  works  which 
have  emanated  from  his  country,  notices  of  which 
have  appeared  from  time  to  time  in  our  columns  du- 
ring the  last  few  months.— London  Lancet,  Dec.  15, 
1866. 

These  additions  make  the  work  much  more  valua- 
ble, and  it  must  be  accepted  as  the  most  complete 
monograph  on  the  subject,  certainly  in  our  own,  if 
not  even  in  any  other  language.— American  Journal 
Med.  Sciences,  Jan.  1867. 

This  is  the  most  complete \reatise  on  the  subject  in 
the  English  language.—  Ranking' s  Abstract,  Jan.  1867. 

I     A  mirror  of  all  that  is  valuable  in  modern  surgery. 

1  Richmond  Med.  Journal,  Nov.  1866. 


BRODIE'S  CLINItAL  LECTURES  ON  SURGERY. 
1  vol.  8vo.,  350  pp.;  cloth,  $1  25. 

HARWELL'S  TREATISE  ON  DISEASES  OF  THE 
JOINTS.  With  illustrations.  1  vol.  8vo.,  of  about 
500  pages  ;  extra  cloth,  $3  00. 

COOPER'S  LECTURES  ON  THE  PRINCIPLES  AND 
PBACTICB  OF  SURUERY.  In  one  very  large  octavo 
volume,  extra  cloth,  of  700  pages.  $2  00. 

fiIBSON'8  INSTITUTES  AND  PRACTICE  OF  SUR- 
OBRT.  Eighth  edition,  improved  and  altered.  With 
thirty-four  plates.  In  two  handsome  octavo  vol- 
umes, about  1000  pages,  leather,  raised  bands.  $6  50 

JONES'   PRINCIPLES   AND    PRACTICE   OF  OPH- 


THALMIC MEDICINE  AND  SURGERY.  With  one 
hundred  and  seventeen  illustrations.  Third  and 
revised  American,  with  Additions  from  the  second 
London  edition  In  one  handsome  octavo  'volume 
of  455  pages,  extra  cloth.  $3  25. 
MACKENZIE'S  PRACTICAL  TREATISE  ON  DIS- 
EASES AND  INJURIES  OF  THE  EYE.  From  the 
fourth  revised  and  enlarged  London  edition.  With 
Notes  and  Additions  by  ADDING  M*  HEWSOJC,  M.  D., 
Surgeon  to  Wills  Hospital,  &c.  &c.  In  one  very 
large  and  handsome  octavo  volume  of  1027  pages, 
extra  cloth,  with  plate*  and  numerous  wood-cuts. 
*<5  50. 


HK.NRY  C.  LEA'S  PUBLICATIONS — (Surgery).  29 

rrOYNDEE  (JOSEPH),  F.R.S., 

*  Aiirnl  Surgeon  to  and  Lecturer  on  Surgery  at  St.  Jfary't  Hospital. 

TIIK   WSBA8E8  <>F  THK  K.\K:  tlu-ir  .Vumv,  IMuirnosis,  and  Treat- 

ment.     With  one  hundred  engravings  on  wood.     Second  American  edition.     In  one  very 
handsomely  printed  o«-ta\o  \...ume  of  4.40  pages;  extra  cloth,  $4. 


The  appearance  of  a  volume  ofMr.  Toynbee'ii,  there- 
fore,  in  which  tin-  -ul'ject  of  aural  disease  i- 
to  the  moHt  -cientitlc  manner,  and  oar  knowledge  in 
•  to  it  placed  fully  on  a  par  with  that  which 


The  work,  a*  WHS  stated  at  the  outset  o'oar  notice, 
Is  a  model  of  its  kind,  and  every  page  and  paragraph 
of  it  are  worthy  of  the  most  thorough  study.  Con- 
sidered all  in  all — as  an  original  work,  well  written, 


Wt.  p, ,„,.,.,.,  ,.  .        -t  o(h«r  organs  of  the  body,     philo«ophlcally  elaborated,  Mrf    i.<i'l'>i.v 

U  a  matter  for  sincere  congralui  ••••>  and  drawing!- — it  I*  by  far  the  abt«*t  mo- 

•onably  hope  that  henceforth  ti  _-r.ij,h  that  ha«  ever  appeared  on  the  anatomy  and 

Use  will  cease  to  be  uni.nu-  the  upprobria  of  medical    diseases  of  the  ear,  and  one  of  the  most  valuable  con- 
science.— London  Medical  Review.  tributioos  to  the  art  and  science  of  Burgeiy  in  the 

I  nineteenth  century.— >'.  Am.  Med.-CHirurg.  Review. 


T  A  r/.'A'.Vf  '/•;  .;./'>//.y  7..\  /•'.  /.'.  C.  S.,    and      MOON  (ROBERT  C.), 

±J  Review,  Ac.  "*11      a'>™ ',Sur%™*?  toeSouthvark  Op*- 

tliiiiniK-  l/'Utptiril,  Ac. 

A  IIANDV-IJOOK   OF    OPHTHALMIC    SURGERY,  for  the  use  of 

•itioners.   *With  numerous  illustrations.     In  one  very  handsome  octavo  volume,  extra 
cloth.     $2  50.     (Just  Issued.) 

No  book  ."                          -nrgery  was  more  n !    I  Not  only,  as  Its  modest  title  suggests,  a  "Handy- 

•i-  Book"  ot '  Opliihalmic  Surgery,  but  an  excellent  and 

It  epito-  well-digexled  retttant  of  all  that  is  of  practical  value 

ioural  to  t)if  eye  in  a  cle;ir  n.                        y. — Seio   1'urk  Medical  Journal,  No- 

.  enabling  the  practi-  v«mber,  IWJti. 
•. 

ance  of  proper  ;  Thts  ohjpct  the  authors  have  accomplished   in  a 

"  *  1                                :'  highly  satisfactory  manner,  and  we  know  no  work 

'."  w.-  run  more  highly  recommend  to  the  "bu«y  practi- 

'-•  (i';  tioner"  who  wi«.h«w  to  make  himself  acquainted  with 

We  <•                                 •   1  this  book  to  the  notice  of  the  r.-c.-nt  improvements  in  ophthalmic  science.    Such 

our    i                                       <   an  excellent  outline  of  a  work  as  this-  w»«  ninth  wanted  at  this  time,  and 

in.. .le:  i.  ophthalmic  aorgerj. — British  Jfed.  Journal,  this  want  Messrs.  Laurence  and  Moon  have  now  well 

i  supplied.—  Am.  Journal  Med.  Science*,  Jan.  1867. 

T  A  WSOX  (GEORGE],  F.  R.  C.  &,  1 

J  J  n  t'i  tli>-  K'lyil  Ismdon  Ophtludwic  Hospital,  Xoorjtelds,  Ac. 

IN.ITKIKS  (>K  THK   KVK.  OIIIJIT,  AND   KVKI.IDS:  their  Imme- 

diate   and  Remote  Effects.      With  about  one  hundred  illustrations.     In  one  very  hand- 
some octavo  volume,  extra  cloth,  $3  50.      (.\uu-  lln«l y.) 

This  work  will  be  found  eminently  fitted  for  the  general  practitioner.  In  cases  of  functional 
ir  structural  di<*as>es  of  the  eye.  the  physician  who  has  not  made  ophthalmic  surgery  a  special 
•tudy  can,  in  tii'..*t  instances,  refer  a  patient  to  some  competent  practitioner.  Cases  of  injury, 
however,  supervene  suddenly  and  usually  require  prompt  assistance,  and  a  work  devoted  espe- 
cially to  them  cannot  but  prove  essentially  u.-eful  to  those  who  may  at  any  moment  be  calleff  upon 
to  treat  such  accident?.  The  present  volume,  as  the  work  of  a  gentleman  of  large  experience, 
may  be  considered  as  eminently  worthy  of  confidence  for  reference  in  all  such  emergencies. 

It  it  an  admirable  practical  book  in  the  highest  and    fulne-s  Of  practical  knowledge.    We  predict  for  Mr. 

best  sense  of  the  phrase,     ('..piously  illustrated  by     I.aw.son's  work   a  great  and  well-merited  success. 

nt   wm>dcui«,   and  with    well-selected,  well-    We  are  confident  that  the  profession,  and  especially, 

described  canes,  it  is  written  in  plain,  simple  Ian-  '  as  we   have  said,  our  country  brethren,   will   feel 

guage,  and  in  a  style  the  transparent  clearness  and    grateful  t»  him  fur  having  given  them  in  It  a  guide 

iraukness,  no  tu  spiMk,   .if  which,  add  greatly  to  its     xnd  cuiin^ellur  fully  up  to  the  most  advanced  state  of 

value  and  usefulness-.     Ouly  a  master  ui  his  subject     ophthalmic  Surgery,  and  of  whom  they  ran  make  a 

-.write;  every  topic  is  handled  with  .-lyand   lam  -  London  Medical    ~ 

..   and    xtraightfurwardi,  ..w   the    ami  Uiiictte,  May  18,  18<>7. 

skilful   and   highly  educated   surgeon  writiug   from 


/  Clinical  Surgery  to  Univertity  Collrgt  Hospital. 

LBCTtlKES  ON  i>isK.\si;s  oi-  TIIK  i  KI.NAKY  o  in  JANS.   With 

illustrations  on  wood.     In  one  neat  octavo  volume.      (Preparing  for  earl 


BORLAND  (W.  W.),  M.D. 


DISKASKS   OF  THK  URINAHV   OIKJANS;  a  Comiu-ndium  of  thrir 

Diagnosis,   Pathology,  and  Treatment.     With  illustrations.      In  one  large  and  handsome 
octavo  volume  of  about  t>UO  pages,  extra  cloth.     $3  50. 

Taken  as  a  whole,  w.- c»n  reconiumnd  Dr.  Morlaud'n  I  of  every  medical  or  surgical  practitioner.—  Brit,  and 
compendium  as  a  very  de»irable  addition  lo  the  library  |  >l/r   Med.-Uhir.  Rmtu>,  April,  1M9. 

fji:i;u\f;  (T.  /?.),  F.I: 

Surgam  to  thr  Is>n<t»n  H"*jtll'il,  Frtitiiltnt  of  the  lluntrrian  Society,  *C. 

A    PRACTICAL    TUKATISK    «>N    HISKASKS    OK    THK    TKSTIS, 

SI'KKMATIC  CORD,  AND  SCROTUM.     Second  American,  from  the  second  and  enlarged 
tab,  edition.     In  one  handsome  octavo  volume,  extra  cloth,  with  numerous  illustra- 
tions,    pp.  420.     $2  00  i 


30 


HENRY  C.  LEA'S  PUBLICATIONS — (Surgery). 


WALES  (PHILIP  S.),  M.  D.,  Surgeon  U.  S.  N. 


MECHANICAL  THERAPEUTICS:  a  Practical  Treatise  on  Surgical 

Apparatus,  Appliances,  and  Elementary  Operations  :  embracing  Minor  Surgery,  Band- 
aging,  Orthopraxy,  and  the  Treatment  of  Fractures  and  Dislocations.  With  six  hundred 
and  fortv-two  illustrations  on  wood.  In  one  large  and  handsome  octavo  volume  of  about 
700  pages:  extra  cloth,  $5  75;  leather,  $6  75.  (Just  Issued.) 

A  Naval  Medical  Board  directed  to  examine  and  report  upon  the  merits  of  this  volume,  officially 
states  that  "  it  should  in  our  opinion  become  a  standard  work  in  the  hands  of  every  naval  sur- 
geon;" and  its  adoption  for  use  in  both  the  Army  and  Navy  of  the  United  States  is  sufficient 
guarantee  of  its  adaptation  to  the  needs  of  every-day  practice. 

The  title  of  this  book  will  give  a  reasonably  good  It  is  the  completestbook  on  these  subjects  we  know 
idea  of  Us  scope,  but  its  merits  can  only  be  appreci-  of,  and  it  cannot  fail  to  be  exceedingly  useful  to  the 
ated  by  a  careful  perusal  of  its  text.  No"  one  who  un-  busy  practitioner,  especially  to  the  busy  country  phy- 
dertakes  such  a  task  will  have  any  reason  to  com-  .  sician  who  has  thrown  upon  his  care  something  of 
plain  that  the  author  has  not  performed  his  duty,  and  surgery  in  its  various  details,  with  all  manner  of  gene- 
has  not  taken  every  pains  to  present  every  subject  in  ral  practice,  and,  therefore,  may  often  wish  to  refresh 
a  clear,  common-sense,  and  practical  light.  It  is  a  himself  as  to  the  most  convenient  and  elegant  modes 
unique  specimen  of  literature  in  its  way,  in  that,  :  of  dressings  and  manipulations. — Cincinnati  Lancet 
treating  upou  such  a  variety  of  subjects,  it  is  as  a  and  Observer,  Jan.  1863.  . 

whole  so  completely  up  to  the  wants  of  the  student  j  We  nave  examined  Dr.  Wales'  book  with  much 

and  the  general  practitioner.     We  have  never  seen  care>  and  believe  that  his  labor  will  greatly  benefit 

any  work  of  its  kind  that  can  compete  with  it  in  real  tne  practitioner  of  surgery.     It  seems  to  us  especially 

utility  and  extensive  adaptability.     Dr.  Wales  per-  beneficial  to  the  country  medical  practitioner  who  is 

fectly  understands  what  may  naturally  be  required  surgeon,  physician,  and  obstetrician,  as  occasion  re- 

of  him  in  the  premises,  and  in  the  work  before  us  has  quires.     \ve  commend  the  work  to  our  readers  as  a 

bridged  over  a  very  wide  gap  which  has  always  here-  most  usefui  one.—Xashville  Med.  and  Surg.  Journal, 

tofore  existed  between  the  first  rudiments  of  surgery  jan   jggg. 
and  practical  surgery  proper.     He  has  emphatically 

given  us  a  comprehensive  work  for  the  beginner  ;  and  ,.  The  title  of  the  above  work  is  sufficiently  indica- 

when  we  sav  of  his  labors,  that  in  their  particular  tive  of  its  contents      We  have  not  seen  for  a  long 

sphere  they  leave  nothing  to  be  desired,  we  assert  a  lme  <m  the  Engllsl1  language)  a  treatise  equal  to  thu 

great  deal  to  recommend  the  book  to  the  attention  of  »*   extent    nor   one  which  is   better  adapted  to  the 

those  specially  concerned.     In  conclusion,  we  would  wants  °.f  the  general  student  and  practitioner. 


ers  who,  without  any  special  pretensions  to  surgery, 


are  occasionally  liable  to  treat  surgical  cases. — 2f.  Y. 
Med.  Record,  March  2,  1S68. 

It  is  certainly  the  most  complete  and  thorough  work 
of  its  kind  in  the  English  language.  Students  and 
young  practitioners  of  surgery  will  find  it  invaluable. 
It  will  prove  especially  useful  to  inexperienced  coun- 
try practitioners,  who  are  continually  required  to 
take  charge  of  surgical  cases,  under  circumstances 
precluding  them  from  the  aid  of  experienced  surgeons. 
— Pacific  Med.  and  Surg.  Journal,  Feb.  1868. 

This  is  a  most  complete  and  elegant  work  of  673 
pages,  and  is  certainly  well  deserving  of  the  com- 
mendation of  every  American  surgeon.  This  work, 
besides  its  usefulness  as  a  reference  for  practitioners, 
is  most  admirably  adapted  as  a  text-book  for  sludents. 
Its  642  illustrations  in  wood-cuts,  represent  every  man- 
ner of  surgical  appliance,  together  with  a  minute  de- 
scription of  each,  the  name  of  its  inventor,  and  its  prac- 
tical utility  in  mechanical  surgery.  There  is,  perhaps, 
no  work  in  the  English  language  so  complete  in  the 
description  and  detail  of  surgical  apparatus  and  ap- 
pliances as  this  one.  The  entire  work  entitles  the  au- 
thor to  great  credit  for  his  clear  and  distinct  style  as 
a  writer,  as  well  as  for  his  accuracy  of  observation 
and  great  research  in  the  field  of  surgery.  We  ear- 
nestly recommend  every  member  of  the  profession  to 
add  a  copy  of  it  to  his  library,  with  the  assurance 
that  he  will  find  some  useful  suggestion  in  the  treat- 
ment of  almost  every  surgical  case  that  may  come 
under  his  observation. — Humboldt  Med.  Archives, 
Feb.  1S68. 


porter,  Feb.  1868. 


A  useful  book  is  always  a  necessary  one,  and  that 
this  book  is  eminently  one  of  that  character,  needs 
but  a  glance  at  its  pages  to  show.  It  certainly  de- 
serves a  place  in  the  library  of  every  physician. — 
Leauenworth  Med.  Herald,  Feb.  18(38. 

The  book  seems  to  be  complete  in  every  respect, 
and  is  a  welcome  addition  to  our  shelves. — Boston 
lied,  and  Surg.  Journal,  Jan.  9,  186$. 

In  our  opinion  it  is  a  good  book,  and  one  which 
every  student  and  practitioner  needs  in  his  library. 
Especially  would  its  value  be  appreciated  by  the  sur- 
geon whose  field  of  practice  is  anywise  remote  from 
the  larger  cities. — Chicago  Med.  Journal,  Jan.  1S68. 

This  volume  will  be  a  useful  acquisition  to  a  large 
number  of  the  working  members  of  the  medical  pro- 
fession in  this  country.  Practitioners  will  find  mate- 
rial aid  and  encouragement  in  its  pages  which  they 
could  nowhere  else  obtain,  to  the  same  extent,  in  so 
convenient  a  form. — Am.  Journal  Med.  Sciences,. 
Jan.  1868. 

He  must  be  a  blockhead  indeed  who,  after  study- 
ing this  portion  of  the  book  before  us,  tails  to  adapt 
himself  to  the  emergen«y  of  any  case,  for  we  find 
here  described  pretty  much  every  contrivance  ever 
devised,  and  we  can  hardly  conceive  of  that  combi- 
nation of  circumstances  which  would  deprive  us  of 
all  these  means  of  assistance,  and  the  absence  of  on« 
or  more  of  the  usual  aids  would  only  stimulate  the 
ingenuity  to  devise  some  other  plan  of  relief. — Alt-Mi 
York  Med.  Journal,  May,  1868. 


A  SET  ON  (T.  J.) 
OX  THE   DISEASES,  INJURIES,  AND  MALFORMATIONS   OF 

THE  RECTUM  AND  ANUS;  with  remarks  on  Habitual  Constipation.  Second  American, 
from  the  fourth  and  enlarged  London  edition.  With  handsome  illustrations.  In  one  very 
beautifully  printed  octavo  volume  OT  about  300  pages.  $3  25.  (Jitft  Issued.) 

The  short  period  which  has  elapsed  since  the  ap- 
pearance of  the  former  American  reprint,  and  the 
numerous  editions  published  in  England,  are  the  best 


We  can  recommend  this  volume  of  Mr.  Ashton's  in 
the  strongest  terms,  as  containing  all  the  latest  details 
of  the  pathology  an-d  treatment  of  diseases  connected 
with  the  rectum. — Canada  Med.  Journ.,  March,  1S66. 

One  of  the  most  valuable  special  treatises  that  the 
phvsician  and  surgeon  can  have  in  his  library. — 
Chicago  Medical  Examiner,  Jan.  1S66. 


arguments  we  can  offer  of  the  merits,  and  of  the  use- 
lessness  of  any  commendation  on  our  part  of  a  book 
already  so  favorably  known  to  our  readers. — Boston 
Med.  and  Surg.  Journal,  Jan.  '26,  1866. 


HENRY  C.  LEA'S  Pt  HI.ICATIONS — (Medical  Jurisprudence,  <£e.)-     31 


*  Lecturer  on  Med.  Juris]),  and  Ohemitiry  in  Guy't  Hospital. 

MEIHt'AI.   .irmsiMJUiKNCK.     Sixth    American,  from   the  eighth 

and  n-M-'.l  L<>ndon  edition.  With  Notes  and  References  to  American  Decisions,  by  CLB- 
JIE.NT  B.  PKNROSB,  of  the  Philadelphia  Bar.  In  one  large  octavo  volume  of  776  pages, 
extra  cloth.  $4  50  ;  leather,  $5  60.  (Just  It  rued.) 

Considerable  additions  have  been  made  by  the  editor  to  this  edition,  comprising  some  important 
sections  from  the  author's  larger  work,  "  The  Principles  and  Practice  of  Medical  Jurisprudence,'' 
as  well  as  references  to  American  law  and  practice.  The  notes  of  the  former  editor,  Dr.  Harts- 
borne,  have  likewise  been  retained,  and  the  whole  is  presented  as  fully  worthy  to  maintain  the 
distinguished  position  which  the  work  hag  acquired  as  a  leading  text-book  and  authority  on  the 
wbjeet. 


A  new  edl 
aril  authon 


ilion  of  a  work  acknowledged  as  a  stand- 


ity  everywhere  within  the  range  of  the 
Knelish  language  Considering  the  new  matter  intro- 
-hiniasis  and  other  subjects,  aud  the 
plates  representing  the  crystals  of  poisons,  etc.,  it  may 
fairly  be  regarded  as  the  most  compact,  comprehen- 
sive, and  practical  work  on  medical  jurisprudence 
which  ha-  i  — u.'. l  from  the  press,  and  the  one  beat 
r  students. — Pacific  Med.  and  Surg.  Journal, 


Feb.  ltt>7. 

The  «ixth 
In  charge  of  a  n-'W 
delphia  bar,  wl 


elaborate  treatises.—  New  York  Medical  Record,  Feb. 
U,  18«7. 

The  present  edition  of  this  valuable  manual  Is  a 
great  improvement  on  those  which  have  preceded  It 
Some  admirable  instruction  on  the  subject  of  evidence 
and  the  duties  and  ^p»pon*ibtlitiea  of  medical  wit- 
nesses has  been  added  by  the  distinguished  author, 
and  some  fifty  cuts,  illustrating  chiefly  the  crystalline 
forms  and  microscopic  structure  of  substances  used 


as  poisons,  inserted.    The  American  editor  baa  also 
pnlar  work  comes  to  ns    lntreauc      8tv«nt!  chapters  from  Dr.  Taylor's  larger 


Mr   Peurose   of  the  Phila-    work.  "The  Principles  and  Practice  of  Medical  Jurig- 

much  to  render  it  useful,  j  prudence,"  relating  to  trichiniaals,  sexual  malforma- 

not  only  t.,  ,,ers  of  this  country,  |  tion  insanity  as  affecting  civil  responsibility,  suicidal 

n.     Wisely  retaining    «"»»««.  and  life  Insurance  Ac  ,  which  add  considerably 
American  editor.    Dr.    to  its  value.     Beside*  this  be  has  introduced  nnnie- 


....................  „   „-..„.,    .... 

has  added  many  valuable  notes  of  his    rou»  references  to  cases  which  have  occurred  in  this 

mmkM  ****&  far  ,the  be,lit  «ttide-bwlt 
rtment  of  medicine  for  students  and  the 


,*    a  a  os 

:  Ion  of  Dr.  Taylor's  work  Is  so  well    ?oun'ry;    U  mmkM  ****     far  the  belit  «ttide-bwlt 

ished.  that  it  needs  no  recommendation.     He  is    ln  this  depa 


own. 

n?i  the  blgheit  iivTnV«a"thorrty"on7li"marters"con-  general  practitioner  In  our  language.— Button  Mtd. 
nected  with  forensic  medicine,  and  every  successive  i  and  Surlf-  Journal,  Dec.  27,  18W. 
edition  of  bis  valuable  work  gives  fresh  assurance  to  Taylor's  Medical  Jurisprudence  has  been  the  text- 
hi«  many  admirers  that  he  will  continue  to  maintain  book  in  our  colleges  for  years,  and  the  present  edi- 
bls  well-earned  position.  No  one  should,  in  fact,  be  tlon,  with  the  valuable  additions  made  by  the  Ameri- 
without  a  t.-x'-t.  ...k  on  the  subject,  as  be  does  not  |  can  editor,  render  it  the  most  standard  work  of  the 

day,  on  the  peculiar  province  of  medicine  on  which 
U  treats.  The  American  editor,  Dr.  Harts  home,  baa 
done  his  duty  to  the  text,  and,  upon  the  whole,  we 

and  thoroughly  practical  work  upon  the  subject,  we  cannot  but  consider  this  volume  the  best  and  richest 
w  iuld  ••:irn..-i'y  i .  ••"iiinifiul  this,  as  forming  the  best  treatise  on  medical  jurisprudence  in  our  language.— 
groundwork  for  all  their  future  studies  of  the  more  i  Brit.  Am.  Med.  Journal. 


emergency  for  its  n»e.    To  those  who  are  not  the  for- 
tunate possessor*  of  a  reliable,  readable,  Interesting, 


ir 


(FORBES),  11. D.,  D.  C.L.,  Ifc. 
ON  OBSCURi:   DISEASES  OF  THE  BRAIN  AND  DISORDERS 

OF  TMK  MINI*:  their  incipient  Symptoms,  Pathology,  Diagnosis,  Treatment,  and  Pro- 
phylaxis. Second  American,  from  the  third  and  revised  English  edition.  In  one  handsome 
octavo  volume  of  nearly  600' pages,  extra  cloth.  $4  25.  (Just  Issued.) 

Of  the  merits  of  Dr.  Winalow's  treatise  the  profes- :  our  conviction  that  it  is  long  since  so  Important  and 
si. m  has  sufficiently  judged.  It  has  taken  Its  place  in  beautifully  written  a  volume  ban  issued  from  the 
the  front  rank  of  the  works  npon  the  special  depart-  British  medical  press.  The  details  of  the  manage- 
neut  of  practical  medicine  to  which  it  pertains. —  ment  of  confirmed  cases  of  insanity  more  nearly  In- 


Cincinnati  Journal  of  Medicine,  March,  1866. 

It  Is  an  interesting  volume  that  will  amply  repay 
for  a  careful  perusal  by  all  intelligent  reader*. — 
i»nr.iy,,  M'-t  Ks'inti:irr  Feb.  1886. 

A  work  which,  like  the  present,  will  largely  aid 

•  in  r  the  first 

unl  in-iitiil  disease,  is 
practical  value,  and  demands  earnest 
liligent  *'  ;  .nt  of  all  who 

1   the  medical    profession,   and   have 
iu    which    the 
ippinesn  <>  . .-  and   famili.'* 

•  Iv.'il.     Wu  shall  therefore  i 
«»arily  very  imperfect    not.' 

it  and  classical  work  by  expressing 


u»  ad  vi 

attention  and 

I     IV"     "III  I' I •.'.'•• 

t»,..r-i 

w- 1  fit  re  and   I 
»r" largely  in 
bri-f  .. 
Wmslow's  gr 


terest  those  who  have  made  mental  diseases  therr 
special  study;  but  Dr.  Winslow's  masterly  exposi- 
tion of  the  early  symptoms,  and  his  graphic  descrip 
tlons  of  the  insidious  advances  of  incipient  insanity, 
together  with  his  judicious  observations  on  the  treat- 
ment of  disorders  of  the  mind,  should,  we  repeat,  be 
carefully  studied  by  all  who  have  undertaken  the 
responsibilities  of  medical  practice. — Dublin  Medical 

/')'.    -V 

It  is  the  moat  interesting  as  well  as  valuable  book 
that  we  have  seen  for  a  long  time.  It  is  truly  fasci- 
nating.— Am.  Jmir.  Mtd.  Science*. 

l>r    Winslow's  work  will  nn.i  .  npr  an 

unique  position  In  the  m.-.! 
tnre  of  this  country. — London  Me 


il    lil.-ia- 


J  KA  (RENRY  C.) 

^SUPERSTITION     AM)    roRCK:     ESSAYS    Ot    TIfH   WACK11   OF 

LAW,  THK  WAOER  OF   I'.ATII.K.   TI1K  i>l;l>KA  I,.   AND  TORTURE.     In  one  hand- 
some volume  royal  12mo.,  of  406  pages;  extra  cloth,  $2  5t*. 

Ttieropiotis  r.'llr.  ,         y  wiiu-li  Mr.  !.••»  h.-»»    a  humor  so  fine  and  good,  that  he  makes  us  regret  it 

HluMr  ••!  -hows  in  the  fullest  mauucr  lli.'     wa-  not  within  hi*  intent,  as  it  wa«  reitainly  within 

it  ronlticl  and  varying  success,  the  advance*     his  power,  to  render  the  whole  of  h:-  thorough  work 
**i  J  defeats,  by  which  the  progress  of  humane  Icginla-     more  popular  in  manner. — Atlantic  Mm,  • 
lion i  has  been  and  i,  still  marked.    This  work  fills  up  |      T1J*  i*  a  book  of  extraordinary  research.     Mr    !..« 
with  the  fullest  exemplification  and  detail  the  w.-  ;..,,  „„„  |||s  ,„,,,,„,  ,.„„-„,„„,,  .  and  . 

ramarks  which  we  have  ,,,,,,1-d  above.     Aa  a  book  of    ,lrikin,  r,,,.,,rd  ,,f  ,,,e  rn,Hl  MII,..r,mi.ins  of  our  OB. 
•^Jr  :lf  »h«  hl«ne"1     happy  Middle  Age.  could  ,,.,t  po«il,ly  have  been  com- 

»•""•  -  p.,-V   .     .    .    A*  a  wurk  of  mrtOM  iii ,.,u.r.v  a 

When— half  in  spite  of  himself,  as  It  appears — he  i  outlying  point*  of  obsolete  law,  •,  and 

»k«lch>'s  a  •ir.'iic  or  character  in  the  history  of  U-gali/-  i  one  of  the  most  remarkable  books  we4i«v« 

•  rr«r  and  cruelty,  he  betrays  so  artlsllta  feeling,  and  !  met  with. — London  Ath«n<eut»,  Nov.  3,  1SO«. 


32 


HENRY  C.  LEA'S  PUBLICATIONS. 


INDEX    TO    CATALOGUE. 


PAGE 

Abel  and  Bloxam's  Handbook  of  Chemistry  .     11 

Allen's  Dissector  and  Practical  Anatomist  .      6 

American  Journal  of  the  Medical  Sciences  .      1 

Abstract,  Half-Yearly,  of  the  Med   Sciences  .      3 

Anatomical  Atlas,  by  Smith  and  Homer      .  .      6 

Ashton  on  the  Rectum  and  Anus  .        .        .  .30 

Ashwell  on  Diseases  of  Females  .        .        .  .22 

Brinton  on  the  Stomach 17 


Barclay's  Medical  Diagnosis  .....     16 

Barlow's  Practice  of  Medicine       .        .        .        .13 

Barwell  on  the  Joints     ......     28 

Bennet  (Henry)  on  Diseases  of  the  Uterus  .        .    22 
Bowman's  (John  E.)  Practical  Chemistry    .        .     10 
Bowman's  (John  E.)  Medical  Chemistry      .        .     10 
Brande  &  Taylor's  Chemistry        .        .        .        .10 

Brodie's  Clinical  Lectures  on  Surgery  .        .        .28 
Brown  on  the  Surgical  Diseases  of  Women  .        .     22 
Buckler  on  Bronchitis     ......     18 

Bucknill  and  Tuke  on  Insanity     .        .        .        .18 

Budd  on  Diseases  of  the  Liver       .        .        .        .18 

Bumstead  on  Venereal    ......     19 

Bumstead  and  Cullerier's  Atlas  of  Venereal        .     19 
Carpenter's  Human  Physiology    ....      8 

Carpenter's  Comparative  Physiology   ...      8 
Carpenter  on  the  Microscope          ....       8 

Carpenter  on  the  Use  and  Abuse  of  Alcohol         .    1 
Carson's  Synopsis  of  Materia  Medica    .        .        .13 
Chambers  on  the  Indigestions        .        .        .        .17 

Christison  and  Griffith's  Dispensatory          .        .     13 
Churchill's  System  of  Midwifery  . 
Churchill  ou  Diseases  of  Females         .        .        .22 
Churchill  on  Puerperal  Fever        .        .        .        .22 

Clymer  on  Fevers    .......    18 

Colombat  de  I'Isere  on  Females,  by  Meigs   .        .    22 
Condie  on  Diseases  of  Children     .        .        .        .21 

Cooper's  (B.  B.)  Lectures  on  Surgery    .        .        .2 
Cullerier's  Atlas  of  Venereal  Diseases          .        .     19 
Curling  on  Diseases  of  the  Testis  ....     29 

Cyclopedia  of  Practical  Medicine  ....     15 

Dalton's  Human  Physiology  ..... 

De  Jongh  on  Cod-Liver  Oil     .....    13 

' 


Dewees's  System  of  Midwifery      .        .        .        .21 

Dewees  on  Diseases  of  Females     .        .        .        .22 

Dewees  on  Diseases  of  Children    .        .        .        .21 

Dickson's  Practice  of  Medicine      .        .        .        .     18 

Druitt's  Modern  Surgery        .....     28 

Dunglison's  Medical  Dictionary    ....      4 

Dunglison's  Human  Physiology    ....      9 

Dunglison  on  New  Remedies         .        .        .        .11 

Dnnglison's  Therapeutics  and  Materia  Medica    .     11 
Ellis's  Medical  Formulary,  by  Smith   .        .        .13 
Erichsen's  System  of  Surgery        .        .        .        .27 

Erichsen  on  Nervous  Injuries        .        .        .        .27 

Flint  on  Respiratory  Organs  .....     17 

Flint  on  the  Heart  .......    17 

Flint's  Practice  of  Medicine  .....     15 

Fownes's  Elementary  Chemistry  .        .        .        .11 

Fuller  on  the  Lungs,  &c  ......     16 

Gardner's  Medical  Chemistry        .        .        .        .11 

Gibson's  Surgery    .......    28 

Gluge's  Pathological  Histology,  by  Leidy    .        .     1-1 
Graham's  Elements  of  Chemistry  .        .        .        .10 

Gray's  Anatomy      .......      6 

Griffith's  (R.  E.)  Universal  Formulary  ...     12 
Griffith's  (J.  W.)  Manual  on  the  Blood,  &c.  .        .     18 
Gross  on  Urinary  Organs        .....     26 

Gross  on  Foreign  Bodies  in  Air-Passages      .        .     2(5 
Gross's  Principles  and  Practice  of  Surgery  .        .     26 
Gross's  Pathological  Anatomy       .        .        .        .14 

Hartshorne's  Essentials  of  Medicine    .        .        .16 
Hartshorne's  Conspectus  of  the  Medical  Sciences      5 
Habershon  on  Alimentary  Canal  .        .        .        .17 

Hamilton  on  Dislocations  and  '"ractures      .        .     28 
Harrison  on  the  Nervous  System  .        .        .        .18 

Hoblyn's  Medical  Dictionary        ....      4 

Hodge  on  Women    .......    23 

Hodge's  Obstetrics  .......     24 

Hodge's  Practical  Dissections        ....      7 

Holland's  Medical  Notes  and  Reflections      .        .     15 
Horner's  Anatomy  and  Histology        ...      6 
Hudson  on  Fevers,          ......     17 

Hughes  on  Auscultation  and  Percussion       .        .    18 
Hill  on  Syphilis       .......     19 

Hillier's  Handbook  of  Skin  Diseases  .        .    20 

Jones's  (T.  W.)  Ophthalmic  Medicine  and  Surg        28 


PAOE 

Jones  and  Sieveking's  Pathological  Anatomy  .  14 
Jones  (C.  Haudfield)  on  Nervous  Disorders  .  .  18 

Kirkes'  Physiology 8 

Knapp's  Chemical  Technology  .  .  .  .11 
Lea's  Superstition  and  Force  ....  .')! 
Lallemand  and  Wilson  on  Spermatorrhoea  .  .  19 

La  Roche  on  Yellow  Fever 18 

La  Roche  on  Pneumonia,  &c.  .  .  .  .18 
Laurence  and  Moon's  Ophthalmic  Surgery.  .  .  29 

Lawson  on  the  Eye 29 

Laycock  on  Medical  Observation  .  .  .  .16 
Lehmann's  Physiological  Chemistry,  2  vols.  .  9 
Lehmann's  Chemical  Physiology  .  .  .  .9 
Ludlow's  Manual  of  Examinations  .  .  .  5 

Lyons  on  Fever 18 

Maclise's  Surgical  Anatomy -7 

Malgaigne's  Operative  Surgery,  by  Brittan  .        .     27 

Marshall's  Physiology 8 

Markwick's  Examination  of  Urine  .  .  .18 
Mayne's  Dispensatory  and  Formulary  .  .  13 
Mackenzie  on  Diseases  of  the  Eye  .  .  .28 

Medical  News  and  Library 2 

Meigs's  Obstetrics,  the  Science  and  the  Art  .  .  25 
Meigs's  Lectures  on  Diseases  of  Women  .  .  23 

Meigs  on  Puerperal  Fever 23 

Miller's  System  of  Obstetrics          .        .        .        .24 

Miller's  Practice  of  Surgery 27 

Miller's  Principles  of  Surgery       .        .        .        .27 

Montgomery  on  Pregnancy 24 

Morland  on  Urinary  Organs 29 

Morland  on  Uraemia 18 

Neill  and  Smith's  Compendium  of  Med.  Science  .  5 
Neligan's  Atlas  of  Diseases  of  the  Skin  .  .  20 
Neligan  on  Diseases  of  the  Skin  ....  20 
Prize  Essays  on  Consumption  .  .  .  .18 
Parrish's  Practical  Pharmacy  .  .  .  .11 

Peaslee's  Human  Histology 7 

Pirrie's  System  of  Surgery 27 

Pereira's  Mat.  Medica  and  Therapeutics,  abridged  13 
Quain  and  Sharpey's  Anatomy,  by  Leidy  .  .  6 

Banking's  Abstract 3 

Roberts  on  Urinary  Diseases 18 

Ramsbotham  on  Parturition 2~> 

Reese  on  Blood  and  Urine 18 

Rigby  on  Female  Diseases 22 

Rigby's  Midwifery 24 

Rokitansky's  Pathological  Anatomy  .  .  .14 
Royle's  Materia  Medica  and  Therapeutics  .  .  13 
Salter  on  Asthma  .  .  18 


Sargent's  Minor  Surgery  .... 
Sharpey  and  Quain's  Anatomy,  by  Leidy  . 
Simon's  General  Pathology  .... 
Simpson  on  Females  ..... 
Skey's  Operative  Surgery  .... 

Slade  on  Diphtheria 

Smith  (J.  L.)  on  Children        .... 
Smith  (H.  H.)  and  Horner's  Anatomical  Atlas 
Smith  (Edward)  on  Consumption  . 
Solly  on  Anatomy  and  Diseases  of  the  Brain 

Still's  Therapeutics 

Tanner's  Manual  of  Clinical  Medicine  . 

Tanner  on  Pregnancy 

Taylor's  Medical  Jurisprudence     . 
Thomas  ou  Diseases  of  Females    . 
Thompson  on  Urinary  Organs 
Todd  and  Bowman's  Physiological  Anatomy 

Todd  on  Acute  Diseases 

Toynbee  on  the  Ear 

Wales  on  Surgical  Operations        .        .        . 

WalsUe  on  the  Heart 

Watson's  Practice  of  Physic  .... 

West  on  Diseases  of  Females 

West  on  Diseases  of  Children 

West  on  Ulceration  of  Os  Uteri      .        .        . 

What  to  Observe  in  Medical  Cases 

Williams's  Principles  of  Medicine 

Wilson's  Human  Anatomy    . 

Wilson's  Dissector 

Wilson  on  Diseases  of  the  Skin  .  .  . 
Wilson's  Plates  on  Diseases  of  the  Skin 
Wilson's  Handbook  of  Cutaneous  Medicine 
Wilson  on  Healthy  Skin  .... 
Wilson  on  Sperrnatorrhosa  .... 
Winslow  on  Brain  and  Mind 


27 


27 
IS 
21 

t> 

13 
18 
12 

5 
24 
31 
22 
29 

9 

18 
29 
30 
18 
16 
23 
21 
23 
16 
14 

7 

20 
20 
20 
20 
19 
31 


"•55 — 


DATE  DUE 


PRINTED  IN  U    S 


UC  SOUTKHH  REGOML  UBRAB 


A  000  511  648  8 


ons... 


WI  11*5 
1868 


Chambers,  Thomas  King. 
Indigestions.. 


WI  11*5 
CU5i 

1868 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 
IRVINE,  CALIFORNIA  92664 


